Implementation of risk enhancers in ASCVD risk estimation and hypolipidemic treatment eligibility: A sex-specific analysis

Sex-specific data are limited regarding eligibility for hypolipidemic treatment. We aim to explore the sex-specific clinical utility of high sensitivity C-reactive protein(hsCRP) and carotid ultrasound as risk modifiers for hypolipidemic treatment in primary prevention for atherosclerotic cardiovascular disease(ASCVD). We aimed to explore these sex-specific trends in two pooled contemporary independent Greek cohorts (Athens Vascular Registry n=698, 50.9% women and Menopause Clinic n=373, 100% women) of individuals without overt ASCVD. Baseline ASCVD risk was estimated using the Systematic COronary Risk Evaluation-2(SCORE2) tools. Presence of carotid plaque and hsCRP≥2mg/L were integrated as risk-modifiers. Men had increased odds to achieve target LDL-C levels based on ASCVD risk(23.8% vs 17.7%, OR: 1.45 95%CI: 1.05-2.00, p=0.023, for men vs women). Additionally considering carotid plaque or high hsCRP levels did not change this association but reduced on-target LDL-C rate in both sexes. Women had decreased odds of being eligible for hypolipidemic treatment by ASCVD risk estimation(11.5% vs.26.4%, p<0.001) compared to men. The addition of carotid plaque presence or high hsCRP levels and their combination resulted in higher relative increase in hypolipidemic treatment eligibility in women(from 11.5% to 70.9% vs.26.4% to 61.4% for carotid plaque, from 11.5% to 38.5% vs.26.4% to 50.8% for hsCRP and from 11.5% to 79.1% vs.26.4% to 75% for their combination, all for women vs. men, pinteraction<0.001 for all) than men. Implementation of carotid plaque and hsCRP levels increases hypolipidemic treatment eligibility more prominently in women than men. The impact on clinical outcomes in these untreated patients merits further investigation.