Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Division of Cardiology, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27705, USA.
Curr Cardiol Rep. 2022 Oct;24(10):1373-1385. doi: 10.1007/s11886-022-01751-z. Epub 2022 Jul 29.
Women are less often recognized to have cardiovascular disease (CVD) risk and are underrepresented in randomized trials of lipid-lowering therapy. Here, we summarize non-pharmacologic and pharmacologic strategies for lipid-lowering in women of childbearing age, lipid changes during pregnancy and lactation, discuss sex-specific outcomes in currently available literature, and discuss future areas of research.
While lifestyle interventions form the backbone of CVD prevention, some women of reproductive age have an indication for pharmacologic lipid-lowering. Sex-based evidence is limited but suggests that both statin and non-statin lipid-lowering agents are beneficial regardless of sex, especially at high cardiovascular risk. Pharmacologic lipid-lowering therapies, both during the pregnancy period and during lactation, have historically been and continue to be limited by safety concerns. This oftentimes limits lipid-lowering options in women of childbearing age. In this review, we summarize lipid-lowering strategies in women of childbearing age and the impact of therapies during pregnancy and lactation. The limited sex-specific data regarding efficacy, adverse events, and cardiovascular outcomes underscore the need for a greater representation of women in randomized controlled trials. More data on lipid-lowering teratogenicity are needed, and through increased clinician awareness and reporting to incidental exposure registries, more data can be harvested.
女性患心血管疾病（CVD）的风险往往被低估，且在降脂治疗的随机试验中代表性不足。在此，我们总结了育龄妇女的非药物和药物降脂策略、妊娠和哺乳期的血脂变化，讨论了现有文献中特定于性别的结果，并讨论了未来的研究领域。
尽管生活方式干预是 CVD 预防的基础，但一些育龄妇女确实需要药物降脂。基于性别的证据有限，但表明他汀类和非他汀类降脂药物均有益，无论性别如何，尤其是心血管风险高的患者。在妊娠期间和哺乳期使用降脂药物，由于安全性问题，在历史上和现在都受到限制。这通常限制了育龄妇女的降脂选择。在本综述中，我们总结了育龄妇女的降脂策略以及妊娠和哺乳期治疗的影响。关于疗效、不良事件和心血管结局的有限性别特异性数据强调了在随机对照试验中需要更多女性的代表性。需要更多关于降脂致畸性的数据，通过提高临床医生的意识和向偶然暴露登记处报告，可以收集更多的数据。
