Women, lipids and atherosclerotic cardiovascular disease: A call to action from the European Atherosclerosis Society
Gothenburg, August 23, 2023
Cardiovascular health of women is often neglected, with risk underappreciated, diagnosis delayed and treatment less than optimal. This new statement from the European Atherosclerosis Society (EAS) is a ‘call to action’, recommending targeted action to reduce the burden of heart disease, stroke and peripheral arterial disease in women. The statement was published today in The European Heart Journal.1 ‘
According to Co-Chair and EAS Past-President Lale Tokgözoğlu (Hacettepe University Faculty of Medicine, Ankara, Turkey), urgent action is needed to address key gaps in identifying and managing cardiovascular disease in women. ‘There is clear evidence of gender disparity in understanding cardiovascular risk in women and diagnosing and treating risk factors. Clinicians and women also need education about female-specific risk factors during the life course, including pregnancy-related disorders that influence risk or premature menopause, as well as recognising that certain risk factors may be more prevalent or have greater impact in women than men.’
A key focus of the statement was how changes in lipids over the life course impact cardiovascular disease in women. Notably, during menopause transition levels of cholesterol and triglycerides increase, and elevated lipoprotein(a) is more prevalent among women than men over the age of 50 years.2 However, women with high cholesterol are less likely to receive a statin at guideline-recommended intensity than men, despite evidence from clinical trials that statin therapy is as effective in women as in men.3,4 Women also need information to avoid discontinuing lipid lowering treatment early due to perceived side effects.
These inequalities in managing high cholesterol are a particular issue for women with the common inherited high cholesterol disorder, familial hypercholesterolaemia (FH). These women are at risk of a higher cholesterol burden over time than men with FH for several reasons; they are often diagnosed later, undertreated, and also need to discontinue statin treatment when pregnant and breast-feeding. This time off statin treatment exacerbates cholesterol burden in women with FH.5 ‘Familial hypercholesterolaemia exemplifies the issue of undertreatment of high cholesterol in women. It is essential that women with FH are closely monitored before, during and after pregnancy to minimize time off statin treatment,’ commented Co-Chair Dr. Jeanine E. Roeters van Lennep (Erasmus Medical Center, Rotterdam, The Netherlands).
While cardiovascular disease is the leading cause of death in women and men globally, women are at greater disadvantage due to a combination of increasing obesity, diabetes and cardiometabolic disease risk factors, as well as female-specific risk factors. ‘We need to increase awareness of cardiovascular risk in women, recognise the impact of female-specific risk factors, and importantly, intervene and treat elevated risk factors such as high cholesterol early. This EAS statement provides pragmatic recommendations aiming to decrease the burden of preventable cardiovascular disease in women,’ said Professor Lale Tokgözoğlu.
Lead authors comments and key messages
Contact: EAS Office
Dr Carmel Hayes: +46768 61 00 51; E-mail: office@eas-society.org
References
1. Roeters van Lennep JE, Tokgözoğlu LS, Badimon L, Dumanski SM, Gulati M, Hess CN, Holven KB, Kavousi M, Kayıkçıoğlu M, Lutgens E, Michos ED, Prescott E, Stock JK, Tybjaerg-Hansen A, Wermer MJH, Benn M. Women, lipids and atherosclerotic cardiovascular disease: A call to action from the European Atherosclerosis Society. Eur Heart J 2023: DOI: https://doi.org/10.1093/eurheartj/ehad472
2. Simony SB, Mortensen MB, Langsted A, Afzal S, Kamstrup PR, Nordestgaard BG. Sex differences of lipoprotein(a) levels and associated risk of morbidity and mortality by age: The Copenhagen General Population Study. Atherosclerosis 2022;355:76-82.
3. Nanna MG, Wang TY, Xiang Q, Goldberg AC, Robinson JG, Roger VL, et al. Sex differences in the use of statins in community practice. Circ Cardiovasc Qual Outcomes 2019;12:e005562.
4. Cholesterol Treatment Trialists Collaboration, Fulcher J, O’Connell R, Voysey M, Emberson J, Blackwell L, et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet 2015;385:1397-405.
5. Johansen AK, Bogsrud MP, Christensen JJ, Rundblad A, Narverud I, Ulven S, et al. Young women with familial hypercholesterolemia have higher LDL-cholesterol burden than men: Novel data using repeated measurements during 12-years follow-up. Atheroscler Plus 2023;51:28-34.
Notes for editors
The EAS Consensus Panel, comprised of internationally renowned experts in atherosclerosis and cardiovascular disease, was first convened in November 2009 to consider the evidence for non-LDL lipids as risk factors for cardiovascular disease. To 2020 the Panel was co-chaired by Professor John Chapman (France), Professor Henry N. Ginsberg (USA), and Professor Alberico L. Catapano (Italy).
Since 2020, the EAS consensus programme has been overseen by the co-ordinators, Professor Alberico Catapano (Italy), Professor Lale Tokgözoğlu (Turkey) and Professor Kausik Ray (Imperial College London, UK). This EAS panel was co-chaired by Professor Lale Tokgözoğlu (Hacettepe University Faculty of Medicine, Ankara, Turkey) and Dr. Jeanine E. Roeters van Lennep (Erasmus Medical Center, Rotterdam, The Netherlands) and comprised 15 experts from Europe and North America.