Ábel Tatjana, Benczúr Béla, Csobod Éva Csajbókné
Department of Dietetics and Nutritional Sciences, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
János Balassa County Hospital, Ist Department of Internal medicine (Cardiology/Nephrology), Szekszárd, Hungary.
Front Med (Lausanne). 2024 Sep 23;11:1458025. doi: 10.3389/fmed.2024.1458025. eCollection 2024.
Previously published studies have shown that women with type 2 diabetes have a higher risk of atherosclerotic cardiovascular disease than men with type 2 diabetes. The exact reason for this is not yet known. The association between metabolic dysfunction-associated steatotic liver disease and type 2 diabetes appears to be bidirectional, meaning that the onset of one may increase the risk of the onset and progression of the other. Dyslipidemia is common in both diseases. Our aim was therefore to investigate whether there is a sex difference in the pathogenesis and management of dyslipidemia in patients with type 2 diabetes and steatotic liver disease with metabolic dysfunction. While the majority of published studies to date have found no difference between men and women in statin treatment, some studies have shown reduced effectiveness in women compared to men. Statin treatment is under-prescribed for both type 2 diabetics and patients with dysfunction-associated steatotic liver disease. No sex differences were found for ezetimibe treatment. However, to the best of our knowledge, no such study was found for fibrate treatment. Conflicting results on the efficacy of newer cholesterol-lowering PCSK9 inhibitors have been reported in women and men. Results from two real-world studies suggest that up-titration of statin dose improves the efficacy of PCSK9 inhibitors in women. Bempedoic acid treatment has been shown to be effective and safe in patients with type 2 diabetes and more effective in lipid lowering in women compared to men, based on phase 3 results published to date. Further research is needed to clarify whether the sex difference in dyslipidemia management shown in some studies plays a role in the risk of ASCVD in patients with type 2 diabetes and steatotic liver disease with metabolic dysfunction.
先前发表的研究表明，2型糖尿病女性患动脉粥样硬化性心血管疾病的风险高于2型糖尿病男性。其确切原因尚不清楚。代谢功能障碍相关脂肪性肝病与2型糖尿病之间的关联似乎是双向的，也就是说，其中一种疾病的发生可能会增加另一种疾病发生和进展的风险。血脂异常在这两种疾病中都很常见。因此，我们的目的是研究2型糖尿病合并代谢功能障碍的脂肪性肝病患者在血脂异常的发病机制和管理方面是否存在性别差异。虽然迄今为止大多数已发表的研究发现，男性和女性在他汀类药物治疗方面没有差异，但一些研究表明，与男性相比，女性的治疗效果有所降低。他汀类药物治疗在2型糖尿病患者和代谢功能障碍相关脂肪性肝病患者中应用不足。依泽替米贝治疗未发现性别差异。然而，据我们所知，尚未发现关于贝特类药物治疗的此类研究。关于新型降胆固醇PCSK9抑制剂疗效的结果在男性和女性中报道不一。两项真实世界研究的结果表明，增加他汀类药物剂量可提高PCSK9抑制剂在女性中的疗效。根据迄今为止发表的3期结果，贝派地酸治疗在2型糖尿病患者中已被证明是有效和安全的，并且与男性相比，在女性中降脂效果更显著。需要进一步研究来阐明一些研究中显示的血脂异常管理方面的性别差异是否在2型糖尿病合并代谢功能障碍的脂肪性肝病患者发生动脉粥样硬化性心血管疾病的风险中起作用。
