Cardiovascular Disease in Women: Focus on Lipid Management

Despite dramatic declines in total cardiovascular disease (CVD) mortality among women in the USA, CVD remains the #1 killer of women, causing almost one out of three female deaths in 2016. Hypercholesterolemia is causal in the development of coronary atherosclerosis and incident atherosclerotic cardiovascular disease (ASCVD) events in women, as it is in men. Statins lower atherogenic lipoproteins to a similar degree in both sexes. Meta-analyses demonstrate that women and men at similar risk of major vascular events achieve similar proportional and absolute benefits from statin therapy, even in primary prevention and among individuals at low baseline risk. The evidence for prevention of ASCVD in women with the use of non-statin drugs is limited as no large randomized controlled trials have been adequately powered to evaluate sex differences in response to non-statin therapies. However, current guidelines for the use of non-statin therapies for management of dyslipidemia for women are the same as those for men. Clinically significant adverse drug effects and self-reported drug allergies have been reported to occur more frequently among women than men for a number of drug classes, and clinicians should be aware of potential sex differences in adverse events. There are important considerations in management of dyslipidemia in women across the lifespan, particularly during conception, pregnancy, and lactation.