Key result
The Japan Atherosclerosis Society guidelines recommend using the Suita score and carotid ultrasound to guide dyslipidemia treatment in women, as their cardiovascular risk remains lower than men's despite higher postmenopausal LDL-C levels.
Gender differences in cardiovascular risk and lipid profiles suggest that dyslipidemia management in Japanese women should incorporate carotid IMT assessment and specific dietary modifications rather than relying solely on standard risk scores.
Supports sex-specific dyslipidemia strategies in practice; leaves open need for prospective validation beyond Level 5 evidence.
The National Health and Nutrition Survey conducted by the Ministry of Health, Labour and Welfare of Japan in 2016 revealed that 21.1% of men and 24.8% of women showed high low-density lipoprotein cholesterol (LDL-C) levels (≥ 140 mg/dL), which indicated a higher mean cholesterol level in women than in men. Higher LDL-C values in women than in men have been noted for a long time, and it is speculated that menopause is one of the factors that affect elevated LDL-C levels in women. Despite elevated LDL-C in women, it is well recognized that women are not prone to developing arteriosclerotic lesions. The Japan Atherosclerosis Society has published "Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017" and provided risk stratification charts according to the Suita score system, which was developed in the Suita study. These risk charts were provided based on the lipid level and classical cardiovascular risk factors, and cardiovascular events have been set as end points with detailed treatment goals in the guidelines. Unfortunately, gender differences have not been considered in treatment goals in the guidelines, even though women carry a lower risk of cardiovascular events than men. In this sense, it might be a better idea to determine the adaptation of high LDL-C treatment by statins after using carotid artery ultrasound to check for the presence of atherosclerotic lesions, carotid intima-media thickness (IMT), or plaques. It has been reported that efficient high LDL-C therapy with statins reduces plaque development more effectively in women than in men. In addition, it is important for health care professionals who provide instructions regarding diet and nutrition to understand that dietary nutrients that affect LDL-C level are not cholesterol derived from food, but mainly the intake of saturated fatty acids and trans-unsaturated fatty acids.
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Kishimoto et al. (2018) conducted a review in Dyslipidemia. Dyslipidemia management based on JAS Guidelines 2017 was evaluated. The Japan Atherosclerosis Society guidelines recommend using the Suita score and carotid ultrasound to guide dyslipidemia treatment in women, as their cardiovascular risk remains lower than men's despite higher postmenopausal LDL-C levels.
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