Gender differences and statin therapy

Abstract

We read with interest the Pavanello et al. review on gender differences in the efficacy, safety and tolerability of statin therapy.[1] The authors reported differences between genders in cardiovascular (CV) risk factors, CV morbidity and mortality as well as in statin response and adverse events. These discrepancies may be attributed to hormonal, anthropometric and pharmacokinetic factors as discussed by the authors.[1] Pavanello et al. also commented on current CV guidelines in both men and women. Interestingly, apart from traditional CV predictors,[2] several emerging CV risk factors may differ between men and women.[3] Both atherosclerotic and non-atherosclerotic coronary heart disease may present gender differences.[4] Furthermore, gender may influence acute coronary syndrome (ACS) outcomes and thus it has been included in risk scores such as the CHA2DS2-VASc-HS score.[5] The rates and outcomes of coronary revascularisation procedures may also differ between genders.[6] In terms of genetic factors predisposing to CV diseases, gender differences have also been reported for polymorphisms in genes involved in lipid metabolism such as the ATP-binding cassette transporter A1 (ABCA1), cholesteryl ester transfer protein (CETP), lipoprotein lipase genes and apolipoprotein E genes.[7–9] With regard to drug therapy, CV risk factors are treated less aggressively and less frequently in women than in men,[2] thus contributing to the gender differences seen in CV disease morbidity and mortality. According to statin treatment and gender differences, data from the majority of studies [the Scandinavian Simvastatin Survival Study, the Prospective Pravastatin Pooling Project, the Women of Air Force/Texas Coronary Atherosclerosis Prevention Study, the Heart and Estrogen/Progestin Replacement Study, the Women of Intervention Trial Evaluating Rosuvastatin, the Women in the Pravastatin or Atorvastatin Evaluation and Infection Therapy Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) trial] [10–15] showed that both women and men had benefited from intensive statin therapy and thus, gender should not be a factor in determining who should be treated with intensive statin therapy.