Gender-related lipid and/or lipoprotein responses to statins in subjects in primary and secondary prevention

•A significantly attenuated reduction of low-density lipoprotein cholesterol (LDL-C) in women vs men on drug treatment was noted.•Atorvastatin and simvastatin lead to a significantly larger decrease of LDL-C in men vs women. Lesser differences were noted with fluvastatin.•Women at very high cardiovascular risk are generally better responders to statins compared with women at lower risk.

BackgroundCardiovascular risk in men rises around the fourth decade of life, whereas women appear to be protected by sex hormones until menopause. This, in turn, tends to negatively affect the lipid profile. Since the 1980s, the incidence of cardiovascular diseases has been reported to progressively decline in men, but it has persisted almost unchanged in women. Major clinical trials on statins have been mostly conducted in men and have fostered the introduction of these agents into clinical practice worldwide. However, only few reports have examined a possible differential activity of statins in the 2 genders, providing in some cases opposite findings.ObjectiveTo evaluate gender-related differences in statin responses.MethodsVariations of lipid profile after 1-year of treatment with different statins in 337 dyslipidemic patients (171 men and 166 women).ResultsIn this series of patients, a significantly attenuated reduction of total cholesterol and low-density lipoprotein cholesterol in women vs men on drug treatment was noted after adjustment for dose and statin power (low-density lipoprotein cholesterol: −28.5 ± 11.8% in men vs −22.7 ± 11.8% in women; P < .001).ConclusionsThe present study indicates that statin treatment has a reduced effectiveness in improving the plasma lipid profile in dyslipidemic women vs men. Whether such gender-related differences may have an impact on clinical outcomes remains to be elucidated.