Georgiopoulos Georgios, Delialis Dimitrios, Aivalioti Evmorfia, Georgakis Vasileios, Mavraganis Georgios, Angelidakis Lasthenis, Bampatsias Dimitrios, Armeni Elena, Maneta Eleni, Patras Raphael, Dimopoulou Maria Angeliki, Oikonomou Ermioni, Kanakakis Ioannis, Lambrinoudaki Irene, Lagiou Areti, Xenos Panos, Stamatelopoulos Kimon
Department of Clinical Therapeutics, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Department of Statistics and Insurance Science, School of Finance and Statistics, University of Piraeus, Piraeus, Greece.
Hellenic J Cardiol. 2023 Sep-Oct;73:16-23. doi: 10.1016/j.hjc.2023.02.006. Epub 2023 Feb 17.
Sex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high-sensitivity C-reactive protein (hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention of atherosclerotic cardiovascular disease (ASCVD).
We aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n = 698, 50.9% women and Menopause Clinic n = 373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2 (SCORE2) tools. The presence of carotid plaque and hsCRP ≥2 mg/L were integrated as risk modifiers.
Men had increased odds to achieve target LDL-C levels based on ASCVD risk (23.8% vs. 17.7%, OR: 1.45 95% CI: 1.05-2.00, p = 0.023, for men vs. women). Additionally, considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation (11.5% vs. 26.4%, p < 0.001) compared with men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in a higher relative increase in hypolipidemic treatment eligibility in women (from 11.5% to 70.9% vs. 26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs. 26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs. 26.4% to 75% for their combination, all for women vs. men, p < 0.001 for all) than men.
Implementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than in men. The impact on clinical outcomes in these untreated patients merits further investigation.
关于降血脂治疗的适用性，特定性别的数据有限。我们旨在探讨高敏C反应蛋白（hsCRP）和颈动脉超声作为动脉粥样硬化性心血管疾病（ASCVD）一级预防中降血脂治疗风险修正指标的特定性别临床效用。
我们旨在探讨两个合并的当代独立希腊队列（雅典血管登记处n = 698，女性占50.9%；更年期诊所n = 373，女性占100%）中无明显ASCVD个体的这些特定性别趋势。使用系统性冠状动脉风险评估-2（SCORE2）工具估计基线ASCVD风险。将颈动脉斑块的存在和hsCRP≥2mg/L作为风险修正指标。
基于ASCVD风险，男性达到目标低密度脂蛋白胆固醇（LDL-C）水平的几率增加（男性为23.8%，女性为17.7%，比值比：1.45，95%置信区间：1.05 - 2.00，p = \u003d 0.023，男性与女性相比）。此外，考虑颈动脉斑块或高hsCRP水平并未改变这种关联，但降低了两性的达标LDL-C率。与男性相比，通过ASCVD风险评估，女性符合降血脂治疗条件的几率降低（11.5%对26.4%，p < 0.001）。添加颈动脉斑块存在或高hsCRP水平及其组合导致女性降血脂治疗适用性的相对增加高于男性（颈动脉斑块：女性从11.5%增至70.9%，男性从26.4%增至61.4%；hsCRP：女性从11.5%增至38.5%，男性从26.4%增至50.8%；两者组合：女性从11.5%增至79.1%，男性从26.4%增至75%，所有女性与男性相比，p均< 0.001）。
颈动脉斑块和hsCRP水平的应用使女性降血脂治疗适用性的增加比男性更显著。对这些未治疗患者临床结局的影响值得进一步研究。
