Women, lipids, and atherosclerotic cardiovascular disease: a call to action from the European Atherosclerosis Society

Abstract

Cardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD mortality is now increasing, with the fastest relative increase in middle-aged women. Missed or delayed diagnosis and undertreatment do not fully explain this burden of disease. Sex-specific factors, such as hypertensive disorders of pregnancy, premature menopause (especially primary ovarian insufficiency), and polycystic ovary syndrome are also relevant, with good evidence that these are associated with greater cardiovascular risk. This position statement from the European Atherosclerosis Society focuses on these factors, as well as sex-specific effects on lipids, including lipoprotein(a), over the life course in women which impact ASCVD risk. Women are also disproportionately impacted (in relative terms) by diabetes, chronic kidney disease, and auto-immune inflammatory disease. All these effects are compounded by sociocultural components related to gender. This panel stresses the need to identify and treat modifiable cardiovascular risk factors earlier in women, especially for those at risk due to sex-specific conditions, to reduce the unacceptably high burden of ASCVD in women.

Association between the triglyceride glucose index and atherosclerotic cardiovascular disease in the general population: analysis of the national health and nutrition examination survey 1999–2004

“…Numerous scholars have focused on the association between the TyG index and the risk of single diseases, such as CAD, stroke, PAD, and atherosclerosis; however little attention has been paid to ASCVD. ASCVD, as a composite outcome, is more closely associated with all-cause mortality and adverse cardiovascular event outcomes than a single disease ( 24 – 26 ), and the early identification and management of patients with high-risk ASCVD is of greater clinical value. Hua et al.…”

Dyslipidaemia management in pregnant patients: a 2024 update

“…In the FH group, TC and LDL-C increased by 28.7% and 29.6%, respectively, while in healthy pregnant women, it was 25.4% and 34.2%, respectively. 18 Triglycerides showed an even greater increase, reaching 116% in the FH group, compared to 103.4% in healthy patients ( P < 0.05). Notably, HDL did not exhibit significant differences between the two groups ( P < 0.05).…”

“… 16 , 17 Consequently, the impact of familial hypercholesterolaemia (FH) on cardiovascular health is more pronounced in women than in men. 18 …”

Lipid metabolism during pregnancy: consequences for mother and child

“…In early pregnancy, total cholesterol, LDL-C, triglycerides, and apolipoprotein B (apoB) levels decrease slightly and increase from the second trimester until end of term [ 12 ]. Total cholesterol and LDL-C levels increase approximately 30–50% while triglycerides increase about 50–100% [ 13 ▪▪ ]. HDL-C levels and apolipoprotein A1 (apoA1) increase 20–40% from early pregnancy onwards and plateau around 20–24 weeks [ 12 ].…”