Dyslipidemia is the abbreviation of abnormal lipid metabolism, commonly known as hyperlipidemia or hyperlipoproteinemia. It mainly refers to.
(1) Excessive serum total cholesterol (TC).
(2) High serum triacylglycerol (TG).
(3) Mixed dyslipidemia (both TC and TG are elevated).
(4) Low serum high-density lipoprotein cholesterol (HDL-C).
Dyslipidemia is one of the major risk factors for cardiovascular disease. Since dyslipidemia in men and women have their own different characteristics, how to objectively understand the relationship between dyslipidemia and cardiovascular disease in women as well as the characteristics of interventions, we now summarize for you.
I. Trend of lipid changes in women
Serum lipids and lipoproteins change with age, and there are some differences between male and female gender.
Europe and the United States: TC and LDL-C levels peak at age 60 in women, while in men they peak at about age 50 and begin to decline after age 70.
China: The peak age of TC and LDL-C is about 10 years later than that in Europe and America.
The relationship between dyslipidemia and cardiovascular disease in women
Female lipid metabolism is influenced by female hormones. Large-scale epidemiological surveys have found that estrogen deficiency is an important causative factor in the development of cardiovascular disease in women; the risk of cardiovascular disease in postmenopausal women is significantly higher than that in premenopausal women, and this risk is positively correlated with increasing age and dyslipidemia after menopause.
1.LDL-C
Due to the protective effect of estrogen, blood LDL-C is lower in adult women than in men, and increases rapidly after menopause. Most studies now believe that rising LDL-C should be considered a major risk factor for CHD, regardless of gender.
2.TG
Blood TG also increases with age in women, and this change is more pronounced than in men. Most adult women have lower blood TG than men, but blood TG rises after menopause. In addition, oral contraceptives can promote the increase of blood TG in women. Although it is not certain whether elevated TG is an independent risk factor for CHD in men, Framingham et al. concluded that elevated TG is a likely risk factor for CHD in women.
3.HDL-C
HDL-C is higher in adult women than in men, with a decreasing trend after menopause. In those who do not have high LDL-C, low to moderate HDL-C (<1.29 mmol/L in women) is an independent risk factor for CHD.
4.TC
Elevated total cholesterol in our population is an important cause of increased mortality from coronary heart disease. the Framingham study confirmed that the incidence of myocardial infarction is lower in women than in men at the same level of TC.
III. Interventions for dyslipidemia in women
In 2013, the Global Recommendations for the Prevention and Treatment of Dyslipidemia issued by the International Atherosclerosis Society emphasized that “the aim of interventions for dyslipidemia is to prevent and treat atherosclerotic cardiovascular disease”.
The Expert Consensus on Prevention of Cardiovascular Disease in Chinese Women (2012) recommends achieving ideal lipid levels through lifestyle improvement: LDL-C < 2.6 mmol/L, HDL-C > 1.3 mmol/L, TG < 3.9 mmol/L, non-HDL-C < 3.38 mmol/L, Class I recommendation, Level of Evidence B.
Drugs intervening in dyslipidemia.
TC-lowering drugs: statins, cholesterol absorption inhibitors (ezetimibe), bile acid sequestrants (cauleenamide), and probucol.
TG-lowering drugs: fibrates, niacin and its derivatives, Omega 3 fatty acids.
The Expert Consensus on Cardiovascular Disease Prevention in Chinese Women (2012) recommends
Early detection of cardiovascular disease risk factors by cardiovascular disease risk stratification and assessment in women, and development of interventions based on individual risk factors and risk stratification in women should be an important strategy for women’s health promotion.
1. high-risk women, including those with coronary heart disease (Class I recommendation, Level of Evidence A), and other atherosclerotic diseases or 10-year absolute risk >20% (Class I recommendation, Level of Evidence B), applying lipid-modifying drugs to LDL-C <2.6 mmol/L along with lifestyle improvement.
2. women at very high risk of cardiovascular disease (recent acute coronary syndrome or combination of multiple cardiovascular risk factors that are poorly controlled) for lipid-modifying therapy to achieve LDL-C <2.08 mmol/L (Class IIa recommendation, Level of Evidence B).
3, women with other risks recommended LDL-C ≥ 3.38 mmol/L, combined with multiple risk factors and 10-year absolute coronary risk of 10% to 20%, apply lipid-modifying drugs to reduce LDL-C while improving lifestyle (Class I recommendation, Level of Evidence B).
4, women with LDL-C ≥4.16 mmol/L, combined with multiple risk factors and 10-year absolute coronary risk <10%, apply lipid-modifying drugs to lower LDL-C while improving lifestyle (Class I recommendation, Level of Evidence B).
5, women with LDL-C ≥ 4.94 mmol/L, with or without other combined cardiovascular risk factors, apply lipid-modifying drugs to lower LDL-C while improving lifestyle (Class I recommendation, Level of Evidence B).
6. women aged >60 years with an expected risk of coronary heart disease >10% and high-sensitivity C-reactive protein (hsCRP) >20 mg/L despite no evidence of infection may be treated with statins in conjunction with lifestyle improvement, but the benefit is uncertain (Class II recommendation, Level of Evidence B).
7. For high-risk women with reduced HDL-C or non-HDL-C elevated LDL-C attainment, such as HDL-C <1.3 mmol/L or non-HDL-C (TC minus HDL-C) >3.38 mmol/L, niacin or fibrates may be applied, but the benefit is uncertain (Class IIb recommendation, Level of Evidence B).