Women and Lipids

• There are currently no sex-specific guidelines for the evaluation and management of lipids.

• Lipids are impacted by normal hormonal changes in women throughout their life cycle.

• Management of lipids should incorporate sex-specific CV risk-factors.

• Future trials should focus on increasing women’s participation in trials of lipid-lowering therapies.
• Primary prevention in women

• Statins are indicated in women with ASCVD risk >7.5%.

• Risk enhancing factors include autoimmune diseases, hormones, gestational issues, family history.

• Radiation or chemotherapies for breast cancer are added risk.

• CRP and calcium scores are helpful in risk stratification.

• Nonstatin treatment for LDL

• IMPROVE-IT trial: Simvastatin + ezetimibe OR 0.88 in women vs. 0.9 in men.

• FOURIER trial: Evalocumab + statin OR 0.81 in women vs. 0.86 for men.

• ODYSSEY trial: Similar benefits in women.

• Bempedoic acid: Similar benefits in women.

• REDUCE-IT trial: Icosapent ethyl, an EPA-only omega-3 fatty acid, reduced events with similar benefits in men and women.

• Fibrates-FIELD: Greater benefit in women in reduction of nonfatal MI and reduction in CV mortality, whereas ACCORD trial women had worse CV outcomes on fibrates compared to placebo.