Dyslipidemia in Women: Do They Need Separate Guidelines?

Cardiovascular disease (CVD) is a leading cause of death in women worldwide, with dyslipidemia as a major modifiable risk factor for prevention of atherosclerotic vascular disease. Dyslipidemia is present across the lifetime of women and is influenced by gender specific risk enhancers and hormonal changes during adolescence, pregnancy, and menopause. At present, there are no gender-specific recommendations for lipid management. Compared to their men counterparts, women are often under-screened and under-treated. Physician bias in treating women should be reduced. Women still comprise a small portion of clinical trials for lipid-lowering agents (25–30%) although some of the trials with therapies such as ezetimibe, inclisiran, and bempedoic acid showed greater relative benefit for women. Effective prevention of atherosclerotic CVD (ASCVD) in women should include early screening and periodic surveillance, especially in pregnancy and post-menopausal state. Women with high cholesterol levels in pregnancy face adverse outcomes during and after pregnancy. The safety of lipid-lowering drugs in pregnancy needs special attention. Appropriate lifestyle and pharmacotherapy should be followed for a lifetime to prevent ASCVD.