Dyslipidemia Management in Women and Men. Exploring Potential Gender Differences

Cardiovascular disease (CVD) is the leading cause of death in both men and women. Each year more than 250 000 women die of coronary heart disease (CHD). On average, women develop coronary atherosclerosis a decade later than men do, and on average they develop a myocardial infarction (MI) 10-15 years later than men do. The prior under-representation of women in clinical trials was associated with the general misconception that CHD was primarily a disease of men. While death rates from CVD are declining, more women die of CVD than their male counterparts, in part due to the delay in diagnosis and the older age at which women develop CVD. Although traditional risk factors for the development of CVD such as obesity, diabetes mellitus (DM), cigarette smoking, hypertension, dyslipidemia, and inflammation are similar in both genders, the impact of each individual risk factor and related interventions may differ dramatically by gender. Women also have inherent attributes that modify their CVD risk, such as menopausal status and the use of hormone therapy. This chapter first examines gender differences in CVD risk factors, then specifically focuses on dyslipidemia in women and the effects of estrogen on CVD risk, and finally addresses treatment guidelines for dyslipidemia. The major CVD risk factors include obesity and fat distribution, physical inactivity, diabetes mellitus (now considered a CHD equivalent), metabolic syndrome, smoking, hypertension, dyslipidemia, and inflammation. Family history has been known to be a risk factor for CHD and there is a strong correlation between certain genetic markers and development of CHD. The prevalence of CHD in men and women combined with effective available treatment options, emphasize the importance for physicians and patients to recognize and adequately treat CHD risk factors.