Dyslipidemia, gender, and the role of high-density lipoprotein cholesterol: implications for therapy

Area of Science:

• Cardiology
• Women's Health
• Lipid Metabolism

Background:

• Cardiovascular disease (CVD) is a leading cause of death in US women, exceeding cancer mortality.
• CVD risk factors, symptoms, diagnosis, and treatment differ significantly between men and women.
• Low high-density lipoprotein cholesterol (HDL-C) is a critical risk factor for coronary artery disease (CAD) in women.

Purpose of the Study:

• To highlight the distinct risks and management considerations for cardiovascular disease in women.
• To emphasize the importance of sex-specific targets for high-density lipoprotein cholesterol (HDL-C).
• To address disparities in lipid management and treatment for women with cardiovascular disease.

Main Methods:

• Review of existing literature and clinical data comparing cardiovascular disease in men and women.
• Analysis of the predictive value of lipid profiles, specifically total cholesterol-to-HDL-C ratio, in women.
• Examination of the impact of diabetes on cardiovascular risk in women compared to men.

Main Results:

• Low HDL-C (<45 mg/dL) is associated with increased CAD risk and progression in women.
• Increasing HDL-C shows a more pronounced cardioprotective effect in women than in men.
• The total cholesterol-to-HDL-C ratio is a stronger predictor of CAD in women.
• Diabetic women face disproportionately higher CAD risk due to low HDL-C.
• Lipid-lowering drugs, though effective, are prescribed less frequently to women.

Conclusions:

• Current clinical guidelines do not adequately reflect the need for higher target HDL-C levels (>45 mg/dL) in women.
• Sex-specific approaches are crucial for effective cardiovascular disease prevention and management in women.
• Addressing underprescription of lipid-lowering therapies in women is essential for reducing CVD burden.