Dyslipidemia and Cardiovascular Disease in Women

Abstract

Cardiovascular disease is the major cause of death in women in developed countries. Dyslipidemia is highly prevalent in women, particularly after the menopause. Elevated low-density lipoprotein cholesterol (LDL-C) has been identified as the key lipid parameter in both genders whereas HDL-cholesterol and triglycerides have been more closely associated, in some studies, with cardiovascular risk in women. Menopause has been shown to be associated with an increase in total and LDL-cholesterol and a decrease in HDL-cholesterol (predominantly in the HDL2 subfraction). Despite its beneficial effects on the lipid profile, hormone replacement therapy is not recommended for primary or secondary prevention of cardiovascular disease in women. The latest meta-analysis of statin trials with gender-specific outcomes showed a similar benefit in women and men. The addition of ezetimibe to simvastatin in patients with acute coronary syndromes showed a further reduction of the primary endpoint in both genders. While there are no gender-related differences in drug treatment of dyslipidemia, current guidelines, to avoid overtreatment, strongly suggest risk estimation before initiating lipid-lowering treatment in women without manifest cardiovascular disease.

Genetic Basis for Sex Differences in Obesity and Lipid Metabolism

“…Lipoprotein profiles are altered in women after menopause, and this can be partially reversed by exogenous hormone replacement therapy (11, 24, 29, 113). Androgen levels in men also appear to influence lipid levels and cardiovascular disease risk.…”

Sex differences in obesity: X chromosome dosage as a risk factor for increased food intake, adiposity and co-morbidities

“…In very broad terms, pre-menopausal women are likely to have a lipoprotein profile that is associated with protection against cardiovascular disease (higher concentrations of large high density lipoprotein (HDL) particles), whereas men are more likely to have a profile that is associated with cardiovascular disease risk (including small HDL particles, higher concentrations of small low density lipoprotein (LDL) particles, and increased levels of very low density lipoproteins) [43]. After menopause, lipid levels in women tend to change to resemble those in men suggesting a key effect of gonadal hormones on lipid profiles [44,45]. However, careful analyses of the effects of exogenous estrogen or androgen administration indicates that changes occurring in response to these hormones account for only part of the differences observed in lipid levels between men and women [46].…”

Impact of menopause and diabetes on atherogenic lipid profile: is it worth to analyse lipoprotein subfractions to assess cardiovascular risk in women?

“…Postmenopausal women tend to deteriorate lipid profile that becomes more atherogenic than their premenopausal counterpart [11, 12]. After menopause, total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-c) usually increase, and these changes are accompanied by a decrease in high-density lipoprotein cholesterol (HDL-c) and an increase in triglycerides (TG) [13, 14].…”