Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA.
Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
Cardiovasc Drugs Ther. 2022 Dec;36(6):1197-1220. doi: 10.1007/s10557-021-07273-0. Epub 2021 Oct 18.
While there are physiologic differences in lipid metabolism in men and women, pharmacologic therapy is very effective in both with similar management strategies recommended in the current guidelines for the management of dyslipidemia. Despite similar guidelines for treatment, studies have shown that women have worse control of dyslipidemia than their male counterparts. This may stem from multiple contributing factors including underestimation of cardiovascular disease risk in women, decreased prescription and utilization of lipid-lowering therapies, decreased medication adherence, and higher risk of statin intolerance, all of which may contribute to lower attainment of lipid targets. Furthermore, heart disease is the leading cause of mortality in women, with heart disease noted an average of 7-10 years later than in men. This has historically led to the misperception that women are protected from heart disease and can be treated less aggressively. In fact, traditional risk factors for atherosclerotic cardiovascular disease often impact risk in women to a greater extent than they do in men. Unique risk factors such as pregnancy-related disorders also contribute to the level of risk and therefore warrant consideration in risk stratification. This review summarizes the efficacy of contemporary lipid-lowering therapies in women versus men and discusses the challenges that arise with lipid management in women along with potential ways to tackle these obstacles.
虽然男性和女性的脂质代谢存在生理差异，但药物治疗在两性中都非常有效，目前血脂异常管理指南中推荐了类似的管理策略。尽管治疗指南相似，但研究表明，女性的血脂异常控制情况不如男性。这可能源于多种因素，包括女性心血管疾病风险被低估、降脂药物的处方和使用减少、药物依从性降低，以及他汀类药物不耐受的风险增加，所有这些都可能导致血脂目标的达标率降低。此外，心脏病是女性死亡的主要原因，心脏病的发病时间比男性平均晚 7-10 年。这导致了一个历史上的误解，即女性可以免受心脏病的影响，并且可以不那么积极地治疗。事实上，动脉粥样硬化性心血管疾病的传统危险因素对女性的影响往往比男性更大。独特的危险因素，如与妊娠相关的疾病，也会增加风险，因此需要在风险分层中考虑。本文综述了当代降脂治疗在女性与男性中的疗效，并讨论了女性在血脂管理中面临的挑战，以及解决这些障碍的潜在方法。
