Abstract
BackgroundDespite documented benefits of lipid-lowering treatment in women, a considerable number are undertreated, and fewer achieve treatment targets vs. men.MethodsData were combined from 27 double-blind, active or placebo-controlled studies that randomized adult hypercholesterolemic patients to statin or statin+ezetimibe. Consistency of treatment effect among men (n = 11,295) and women (n = 10,499) was assessed and percent of men and women was calculated to evaluate the between-treatment ability to achieve specified treatment levels between sexes.ResultsBaseline lipids and hs-CRP were generally higher in women vs. men. Between-treatment differences were significant for both sexes (all p < 0.001 except apolipoprotein A-I in men = 0.0389). Men treated with ezetimibe+statin experienced significantly greater changes in LDL-C (p = 0.0066), non-HDL-C, total cholesterol, triglycerides, HDL-C, apolipoprotein A-I (all p < 0.0001) and apolipoprotein B (p = 0.0055) compared with women treated with ezetimibe+statin. The odds of achieving LDL-C < 100 mg/dL, apolipoprotein B < 90 mg/dL and the dual target [LDL-C < 100 mg/dL & apoliprotein B < 90 mg/dL] was significantly greater for women vs. men and the odds of achieving hs-CRP < 1 and < 2 mg/L and dual specified levels of [LDL-C < 100 mg/dL and hs-CRP < 2 mg/L] were significantly greater for men vs. women. Women reported significantly more gall-bladder-related, gastrointestinal-related, and allergic reaction or rash-related adverse events (AEs) vs. men (no differences between treatments). Men reported significantly more CK elevations (no differences between treatments) and hepatitis-related AEs vs. women (significantly more with ezetimibe+simvastatin vs. statin).ConclusionsThese results suggest that small sex-related differences may exist in response to lipid-lowering treatment and achievement of specified lipid and hs-CRP levels, which may have implications when managing hypercholesterolemia in women.
Highlights
Despite documented benefits of lipid-lowering treatment in women, a considerable number are undertreated, and fewer achieve treatment targets vs. men
+statin experienced significantly greater changes in low-density lipoprotein cholesterol (LDL-C) (p = 0.0066), non-high-density lipoprotein cholesterol (HDL-C), total cholesterol, triglycerides, HDL-C, apolipoprotein A-I and apolipoprotein B (p = 0.0055) compared with women treated with ezetimibe+statin
Men reported significantly more CK elevations and hepatitis-related adverse events (AEs) vs. women. These results suggest that small sex-related differences may exist in response to lipid-lowering treatment and achievement of specified lipid and high-sensitivity C-reactive protein (hs-CRP) levels, which may have implications when managing hypercholesterolemia in women
Summary
Despite documented benefits of lipid-lowering treatment in women, a considerable number are undertreated, and fewer achieve treatment targets vs. men. The average lifetime risk for cardiovascular disease (CVD) in women is very high, approaching 1 in 2 [1]. The 2011 update to the Guidelines for Cardiovascular Disease Prevention in Women asserts that most women are at risk for CVD and stresses the importance of CVD prevention and appropriate treatment based on appropriate risk assessment [2]. Full list of author information is available at the end of the article high risk to > 10% 10-year risk for CVD. Recommendations for preventive measures for CVD are similar in men and women. The primary target for men and women is low-density lipoprotein cholesterol (LDL-C)
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