PDF(Pubmed)
Abstract：
Lipid-lowering therapy (LLT) is a cornerstone of atherosclerotic cardiovascular disease prevention. Although LLT might lead to different reductions in low-density lipoprotein cholesterol (LDL-C) levels in women and men, LLT diminishes cardiovascular risk equally effectively in both sexes. Despite similar LLT efficacy, the use of high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors is lower in women compared to men. Women achieve the guideline-recommended LDL-C levels less often than men. Greater cholesterol burden is particularly prominent in women with familial hypercholesterolemia. In clinical practice, women and men with dyslipidemia present with different cardiovascular risk profiles and disease manifestations. The concentrations of LDL-C, lipoprotein(a), and other blood lipids differ between women and men over a lifetime. Dissimilar levels of LLT target molecules partially result from sex-specific hormonal and genetic determinants of lipoprotein metabolism. Hence, to evaluate a potential need for sex-specific LLT, this comprehensive review (i) describes the impact of sex on lipoprotein metabolism and lipid profile, (ii) highlights sex differences in cardiovascular risk among patients with dyslipidemia, (iii) presents recent, up-to-date clinical trial and real-world data on LLT efficacy and safety in women, and (iv) discusses the diverse medical needs of women and men with dyslipidemia and increased cardiovascular risk.
摘要：
降脂治疗(LLT)是动脉粥样硬化性心血管疾病预防的基石。尽管LLT可能导致女性和男性低密度脂蛋白胆固醇（LDL-C）水平的不同降低，LLT同样有效地降低了男女的心血管风险。尽管LLT功效相似，使用高强度他汀类药物，ezetimibe,和前蛋白转化酶枯草杆菌蛋白酶/kexin9型抑制剂在女性中低于男性。女性达到指南推荐的LDL-C水平的频率低于男性。更大的胆固醇负担在家族性高胆固醇血症女性中尤为突出。在临床实践中,血脂异常的女性和男性具有不同的心血管风险特征和疾病表现。LDL-C的浓度,脂蛋白（a），和其他血脂在女性和男性的一生中不同。LLT靶分子的不同水平部分是由脂蛋白代谢的性别特异性激素和遗传决定因素引起的。因此，为了评估对性别特异性LLT的潜在需求，这篇综合综述(I)描述了性别对脂蛋白代谢和脂质分布的影响，（ii）强调血脂异常患者心血管风险的性别差异，(iii)最近的介绍，关于女性LLT疗效和安全性的最新临床试验和真实世界数据，和(iv)讨论了血脂异常和心血管风险增加的男女的不同医疗需求。
