Genetic and Ethnic Determinants of Dyslipidemia in Women: Clinical Trials in Lipid Management, Where are Women?

Cardiovascular disease (CVD) continues to be the leading cause of morbidity and mortality for women globally. While there is a notable gap of approximately 10 years in mortality rates between women and men, this does not diminish the profound burden of heart-related disorders in the female population. Despite this critical public health issue, the management of dyslipidemia, a primary modifiable risk factor for CVD, remains a significant area of unmet need in women’s healthcare. A review of recent literature and professional guidelines reveals a concerning, systemic disparity in the management of dyslipidemia in female patients. Women are demonstrably less likely to be treated with statin therapy, less likely to be prescribed high-intensity regimens when they are, and subsequently, less likely to achieve the lipid goals recommended by professional societies compared to their male counterparts. The downstream effect of this persistent, suboptimal management is that women accumulate a higher burden of atherosclerotic risk over a lifetime of exposure to elevated lipids. The management of dyslipidemia in women is a complex endeavor that necessitates a nuanced, personalized, and lifecycle-based approach. Genetic and ethnic variations in addition to hormonal complexities in the female gender must be at the forefront of clinical consideration. It is insufficient to apply a one-size-fits-all model of care when a woman’s risk profile is dynamically influenced by her unique genetic makeup as well as by pivotal life events such as puberty, pregnancy, and menopause in addition to ethnic variations. Under-representation in clinical trials, undertreatment, and sub-optimal lipid goal attainment, and reproductive health complexities limiting therapy during pregnancy and lactation are persistent gaps in dyslipidemia management in women. Closing the persistent treatment gap for women requires a practical, evidence-based approach. The future of dyslipidemia management is rapidly moving toward more potent and durable therapies that address the root genetic causes of lipid abnormalities. The advancements in RNA-based agents and gene-editing technologies offer the promise of shifting the paradigm from chronic, lifelong medication to single-dose, potentially curative treatments. Continued research in these areas, with a specific focus on understanding and addressing the unique needs of the female patient, will be essential for finally achieving health equity in cardiovascular care.