Dyslipidemia, gender, and the role of high-density lipoprotein cholesterol: implications for therapy

Cardiovascular disease, which kills more US women than all cancers combined, may pose an even greater risk for women than for men. For example, the risk factors, testing modalities, presenting symptoms and the therapeutic choices made for women with coronary artery disease are significantly different from those for men. Low levels of high-density lipoprotein cholesterol (HDL-C), <35 mg/dL in men and <45 mg/dL in women, is associated with a greater risk of coronary artery disease and more progression of angiographically demonstrated disease in women, while increasing HDL-C has a more cardioprotective effect in the female than in the male population. The total cholesterol-to-HDL-C ratio is also more predictive of coronary artery disease in women than in men. Because average HDL-C levels in women are approximately 10 mg/dL higher than in men, target HDL-C should be higher (>45 mg/dL) in women. This is not yet reflected in clinical guidelines. Diabetes is particularly hazardous in women, and low HDL-C levels constitute a disproportionate risk for coronary artery disease in diabetic women compared with diabetic men. Regrettably, although lipid-lowering drugs have been shown to be effective in women, they are more rarely prescribed for women than for men.