Lipid Lowering Therapy Utilization and Lipid Goal Attainment in Women

Overview

Journal Curr Atheroscler Rep

Publisher Springer

Date 2025 Jan 28

PMID 39873822

Authors

Julie A E van Oortmerssen

Janneke W C M Mulder

Marte F van der Bijl

Ruben J M Mijnster

Maryam Kavousi

Jeanine E Roeters van Lennep

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: The purpose of this review is to provide an overview of the current status of lipid-lowering therapy utilization and lipid goal attainment in women. We focus on lipid-lowering therapy in individuals with and without established atherosclerotic cardiovascular disease, as well as familial hypercholesterolemia. Additionally, this review aims to explore the underlying mechanisms driving these sex differences and to identify existing knowledge gaps in this area.

Recent Findings: Despite the proven efficacy of lipid-lowering therapy in both sexes, real-world studies indicate that women with comparable risk profiles are less likely than men to receive these treatments. Furthermore, women who are prescribed statins typically receive lower-intensity regimens than men and are less likely to achieve guideline-recommended low-density lipoprotein cholesterol goals. Despite advancements in lipid-lowering therapies, women compared to men, are systematically undertreated. This difference is influenced by patient-related, physician-related, and societal factors.

References

Ference B, Yoo W, Alesh I, Mahajan N, Mirowska K, Mewada A . Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol. 2012; 60(25):2631-9. DOI: 10.1016/j.jacc.2012.09.017. View

Iatan I, Akioyamen L, Ruel I, Guerin A, Hales L, Coutinho T . Sex differences in treatment of familial hypercholesterolaemia: a meta-analysis. Eur Heart J. 2024; 45(35):3231-3250. PMC: 11400737. DOI: 10.1093/eurheartj/ehae417. View

Barquera S, Pedroza-Tobias A, Medina C, Hernandez-Barrera L, Bibbins-Domingo K, Lozano R . Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease. Arch Med Res. 2015; 46(5):328-38. DOI: 10.1016/j.arcmed.2015.06.006. View

Lee C, Mnatzaganian G, Woodward M, Chow C, Sitas F, Robinson S . Sex disparities in the management of coronary heart disease in general practices in Australia. Heart. 2019; 105(24):1898-1904. DOI: 10.1136/heartjnl-2019-315134. View

Bots S, Onland-Moret N, Jancev M, Hollander M, Tulevski I, Hofstra L . Statins are associated with a large reduction in all-cause mortality in women from a cardiac outpatient population. Open Heart. 2022; 9(1). PMC: 9021779. DOI: 10.1136/openhrt-2021-001900. View

Yu J, Wang A, Zimmerman L, Deng Y, Vu T, Tedla Y . A Cohort Analysis of Statin Treatment Patterns Among Small-Sized Primary Care Practices. J Gen Intern Med. 2022; 37(8):1845-1852. PMC: 9198125. DOI: 10.1007/s11606-021-07191-9. View

Fillingim R, King C, Ribeiro-Dasilva M, Rahim-Williams B, Riley 3rd J . Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain. 2009; 10(5):447-85. PMC: 2677686. DOI: 10.1016/j.jpain.2008.12.001. View

Rosano G, Lewis B, Agewall S, Wassmann S, Vitale C, Schmidt H . Gender differences in the effect of cardiovascular drugs: a position document of the Working Group on Pharmacology and Drug Therapy of the ESC. Eur Heart J. 2015; 36(40):2677-80. DOI: 10.1093/eurheartj/ehv161. View

Boren J, Chapman M, Krauss R, Packard C, Bentzon J, Binder C . Low-density lipoproteins cause atherosclerotic cardiovascular disease: pathophysiological, genetic, and therapeutic insights: a consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2020; 41(24):2313-2330. PMC: 7308544. DOI: 10.1093/eurheartj/ehz962. View

10.

Webster R, Weinman J, James Rubin G . A systematic review of factors that contribute to nocebo effects. Health Psychol. 2016; 35(12):1334-1355. DOI: 10.1037/hea0000416. View

11.

Peters S, Colantonio L, Zhao H, Bittner V, Dai Y, Farkouh M . Sex Differences in High-Intensity Statin Use Following Myocardial Infarction in the United States. J Am Coll Cardiol. 2018; 71(16):1729-1737. DOI: 10.1016/j.jacc.2018.02.032. View

12.

Schwartz A, Alsan M, Morris A, Halpern S . Why Diverse Clinical Trial Participation Matters. N Engl J Med. 2023; 388(14):1252-1254. DOI: 10.1056/NEJMp2215609. View

13.

Fulcher J, OConnell R, Voysey M, Emberson J, Blackwell L, Mihaylova B . Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet. 2015; 385(9976):1397-405. DOI: 10.1016/S0140-6736(14)61368-4. View

14.

Ferri N, Ruscica M, Coggi D, Bonomi A, Amato M, Frigerio B . Sex-specific predictors of PCSK9 levels in a European population: The IMPROVE study. Atherosclerosis. 2020; 309:39-46. DOI: 10.1016/j.atherosclerosis.2020.07.014. View

15.

Hsue P, Bittner V, Betteridge J, Fayyad R, Laskey R, Wenger N . Impact of female sex on lipid lowering, clinical outcomes, and adverse effects in atorvastatin trials. Am J Cardiol. 2015; 115(4):447-53. DOI: 10.1016/j.amjcard.2014.11.026. View

16.

Lewey J, Shrank W, Bowry A, Kilabuk E, Brennan T, Choudhry N . Gender and racial disparities in adherence to statin therapy: a meta-analysis. Am Heart J. 2013; 165(5):665-78, 678.e1. DOI: 10.1016/j.ahj.2013.02.011. View

17.

Hart K, Perlis R . Trends in Proportion of Women as Authors of Medical Journal Articles, 2008-2018. JAMA Intern Med. 2019; 179(9):1285-1287. PMC: 6547141. DOI: 10.1001/jamainternmed.2019.0907. View

18.

Mora S, Glynn R, Hsia J, MacFadyen J, Genest J, Ridker P . Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating.... Circulation. 2010; 121(9):1069-77. PMC: 4439924. DOI: 10.1161/CIRCULATIONAHA.109.906479. View

19.

Metser G, Bradley C, Moise N, Liyanage-Don N, Kronish I, Ye S . Gaps and Disparities in Primary Prevention Statin Prescription During Outpatient Care. Am J Cardiol. 2021; 161:36-41. PMC: 8607804. DOI: 10.1016/j.amjcard.2021.08.070. View

20.

Berger J, Elliott L, Gallup D, Roe M, Granger C, Armstrong P . Sex differences in mortality following acute coronary syndromes. JAMA. 2009; 302(8):874-82. PMC: 2778841. DOI: 10.1001/jama.2009.1227. View