Hi, all:  A couple of weeks ago there was a question about the use of
lipid-lowering drugs in a breastfeeding mom.  In my response, I stated
that the risk of heart disease in women in their child-bearing years is
exceedingly low and that the need for medications to lower the
cholesterol while breastfeeding seemed to be unnecessary in most cases.
It was pointed out to me that some women who may be truly at risk of
heart disease might interpret my posting as false reassurance and may
ignore symptoms of heart disease.  I believe it's important to clarify
this situation a little.
The main risk factors for coronary artery disease are (not in any
particular order): high blood pressure, diabetes, high cholesterol,
smoking, family history of early heart attacks (40's and 50's), male
gender or postmenopausal age in females, and according  to some experts,
sedentary life style and obesity.  Development of plaques in arteries
takes years and probably decades, although significant plaques have been
found on arteries of some young children incidentally at autopsy for
death from some other cause.
The best reference I have found on cholesterol levels in breastfeeding
was by David Oyer, MD and Nell Stone, MD in JAMA, Feb. 17, 1989, Vol 261,
No. 7, p. 1064.  It states that lactating women have higher levels of HDL
and other beneficial lipoproteins.  Some quotes from that paper:
"Lipid screening during lactation is not advised.."  "The effects of
lactation on lipids are actually beneficial....studies of lipoproteins in
lactating women compared with values at 36 weeks' gestation have shown
higher values of high-density lipoprotein cholesterol and apoproteins A1
and A2, lipoprotein fractions associated with a reduced risk of coronary
heart disease.  So, this change with lactation, believed to be due to
increased catabolism of triglyceride-rich lipoproteins, further reduces
the urgency to test or treat lactating women for hyperlipidemia.  Since
pregnant women, as a group, have low rates of coronary heart disease,
lipid testing can be deferred safely (in most cases) until the patient is
no longer breast-feeding, at stable weight, and back to her usual diet
and activity."  "For those with known familial hypercholesterolemia prior
to pregnancy, prior drug therapy can be resumed postpartum after a modest
delay for breast-feeding."
One of the reasons postulated for the low risk of heart disease in
premenopausal women is the cardio-protective high HDL present in most of
these women.  In light of the above, it seems that breastfeeding is a
beneficial component, therefore I reiterate that in most women it makes
little sense to wean for the sake of lipid-lowering drugs.  However, women
who have many of the other risks or whose lipid profile
really is very high risk of course need to weigh their risk of
heart disease without the lipid-lowering agents vs. the benefits of
continuing to nurse.  And, of course, such women should not ignore
symptoms of heart disease.  Just because something is rare does not mean
it could not occur.  Hope this helps.  Alicia.  [log in to unmask]