Women may need stronger lipid-lowering regimens

By Sally Robertson, B.Sc.Jun 7 2012

Women who are at high risk for cardiovascular disease (CVD) are significantly less likely to achieve their lipid-lowering treatment goals than their male counterparts, show findings from a Chinese study.

The main contributor to the gender disparity was pretreatment levels of low-density lipoprotein (LDL) cholesterol, report the researchers, who found that the mean LDL cholesterol level among women prior to initiation of statin therapy was 0.4 mmol/L higher than it was among men.

As reported in Lipids in Health and Disease, an analysis of baseline information for 674 women and 1134 men (aged 23-91 years) who had initiated statin therapy between January 2004 and February 2006 showed that pretreatment LDL cholesterol accounted for 36.6% of the gender disparity in lipid-lowering treatment goal attainment.

The disparity was only significant in the high and very high CVD risk groups, where a mean LDL cholesterol target attainment rate of 46.0% was observed for women, compared with 53.8% for men.

Other factors contributing to the gender disparity were CV comorbidity and associated risk factors, the dosage of statin treatment, and socioeconomic status, which each contributed to 7.3%, 4.9%, and 4.9% of the difference, respectively.

"This phenomenon might in part be explained by the presence of estrogen, which is associated with lowering cholesterol by reducing the LDL cholesterol level through decreased LDL receptors and an increased LDL clearance rate," suggest Yangfeng Wu (Peking University Health Science Center, Beijing) and team.

Ninety percent of the women in this study were postmenopausal, and reduced estrogen in postmenopausal women attenuates the role of statins in reducing LDL cholesterol, they explain.

"Women, particularly post-menopausal women, should focus more attention on their cholesterol levels and be given more intensive treatment than men," remark the researchers, although further studies are required to confirm their findings, they say.

In addition, although nearly half of the gender disparity in lipid-lowering treatment goal attainment could be explained by gender differences in the factors investigated here, the other half of the disparity remains unexplained and requires further research to fully understand what other factors are at play, they conclude.

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