The recently published "Guidelines for Using Serum Cholesterol, High-Density Lipoprotein Cholesterol, and Triglyceride Levels as Screening Tests for Preventing Coronary Heart Disease in Adults" [1] should have been titled "Guidelines for Using Serum Cholesterol, High-Density Lipoprotein Cholesterol, and Triglyceride Levels as Screening Tests for Preventing Coronary Heart Disease in Men." Premature menopause without the benefit of estrogen replacement therapy is an established risk factor for atherosclerosis and should have been included in the list of risk factors. Under the new American College of Physicians guidelines, a 44-year-old diabetic woman with premature or surgical menopause who is not receiving estrogen replacement therapy would have only one risk factor for coronary heart disease and thus would not be eligible for cholesterol screening.

Risk factors for coronary heart disease are influenced by sex. High-density lipoprotein cholesterol levels, triglyceride levels, and diabetes mellitus are more significant risk factors for vascular disease in women than in men. Hormone replacement therapy has been proven to reduce risk for cardiovascular disease in women in the prospective PEPI trial [2]. Coronary artery disease is the leading cause of death in U.S. women. Ignoring the sex-based risks for coronary heart disease is inexcusable. The College's guidelines further the myth that coronary artery disease is a disease primarily of men. Furthermore, these "evidence-based" guidelines rely on studies that have primarily been conducted on middle-aged white men, thus propagating the male paradigm in internal medicine.