Page 6 - reflections_dyslipidaemia_newsletter5_2023

REFLECTIONS
Dyslipidaemia
Dyslipidaemia Global Newsletter #6 2023

The position statement reviews the evidence for a number of topics and provides key points for each: Dyslipidaemia

Do cardiovascular risk factors differ in women?

• The impact of several lifestyle-related risk factors is disproportionately greater in women than in men. Adverse changes
in weight, lipids, blood pressure, and glucose metabolism with menopause transition highlight potential for accelerating
cardiovascular risk.
• Female-specific risk factors, such as pregnancy-associated disorders, should be considered to promote earlier ASCVD risk
factor assessment.
• Gender-related sociocultural contributors also disproportionately influence cardiovascular health in women.

Does cardiovascular risk prediction differ in women?
• Cardiovascular risk prediction based on traditional risk factors over a 10-year span underestimates risk in women.
• Lifetime cardiovascular risk and treatment benefit may be preferable approaches to tailoring cardiovascular disease
prevention in women.

Does sex impact atherothrombosis risk?
• Sex (sex hormones and sex chromosomes) influences the pathogenesis of atherothrombosis, but understanding of the
underlying mechanisms is limited.
• Sex-based mechanisms may contribute to differing susceptibility to bleeding complications from antiplatelet and anticoagulant
therapy in women and men.

Does atherosclerotic cardiovascular disease presentation differ in women?
• Symptoms of ASCVD in women are underappreciated and underrecognized.
• Women have a higher burden of microvascular dysfunction than men.
• For all presentations of ASCVD in women, delayed or missed diagnosis is common and contributes to undertreatment.

Cardiovascular risk factors in women: Focus on lipids
Familial hypercholesterolaemia
• Female sex influences lipids during transitions (pregnancy, breastfeeding, and menopause). After menopause, women
experience a worsening in the lipid profile, potentially contributing to accelerating ASCVD risk.
• The LDL-C burden associated with FH is higher among women than men due to delayed diagnosis, underuse of maximal
statin doses with lower LDL-C goal attainment, and discontinuation of statin therapy before and during pregnancy and
breastfeeding.
• This panel recommends action to minimize time off statin therapy for FH women after pregnancy and breastfeeding.

Triglyceride-rich lipoproteins
• Triglyceride levels are a marker for TRL; remnant cholesterol contained in TRL is important for atherosclerosis.
• The association of increasing TG levels and ASCVD risk is similar in men and women.
• While there is currently no solid evidence that TG concentration is a better predictor of ASCVD in women than in men,
evidence suggests that TRLs are important risk factors for premature CHD in women.

Lipoprotein(a)
• In women, Lp(a) concentration increases during pregnancy, and from the onset of menopause (circa 50 years).
• High Lp(a) levels are more common in women than men after 50 years, which may impact ASCVD risk. This might suggest
that guideline recommendations to measure Lp(a) once are inadequate in women.

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