Lipid control in high-risk patients: women still lag behind men

Your login
Your password
Confirm your password
Your email
I agree to receive the R3i newsletter
Yes No

Focus on...

6 July 2023

While data from the US National Health and Nutrition Survey (NHANES) 2001-2018 showed a trend for improved lipid control among survivors of a stroke or myocardial infarction (MI), women still have poorer lipid control than men.

Dong W, Yang Z. Trends in lipid profile and lipid control among survivors of stroke or myocardial infarction among US adults, 2001–2018. Front Endocrinol 2023;14:1128878

STUDY SUMMARY

Objective:

To investigate the change in lipid profile and lipid control among survivors of stroke and/or MI among US adults from 2001–2018.

Study design:

Analysis of the NHANES database 2001-2018

Study population:

Stroke/MI survivors from the NHANES population aged at least 18 years.

Strudy outcomes:

• Lipid levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides

Methods:

Data were presented as survey-weighted percentages (categorical) or mean (continuous data) with 95% confidence interval (CI). Triglyceride data were log-transformed. Overall trends in lipid concentration and lipid control rate over time were assessed using a general linear regression analysis, and cross-sectionally for the change in lipid control across sex and race subgroups.

Results:

The analysis included 3,736 stroke/MI survivors (mean aged 65.0 years, 54% male, 74% non-Hispanic white). The percentage of subjects who reported taking medication for dyslipidemia increased from 36.1% in 2001 to 2002, to 57.1% in 2017 to 2018. With the exception of HDL-C, there was a decreasing trend in lipid levels between 2001-2002 and 2017-2018. Overall lipid control (defined as total cholesterol ≤ 200 mg/dL) improved from 56.2% (95% confidence interval 43.9% to 67.7%) in 2001-2002 to 73.2% (64.8% to 80.2%) in 2017-2018. However, female stroke/MI survivors were more likely to have poorer lipid control than men; odds ratio (indicative of a higher rate of poor lipid control) for women versus men was 2.7 in 2001-2004, and 1.4 in 2015-2016.

Authors’ conclusion:

In this cross-sectional study, we observed that lipid concentrations decreased in stroke and/or MI survivors. Survivors had improved lipid control, however, there was heterogeneity based on sex and race.

COMMENT

This report from NHANES is generally positive, showing that lipid control has improved over the last 18 years, consistent with other reports and reflecting the impact of updated clinical guidelines for lipid management (1,2). There is, however, worrying news in that improvement in lipid control (defined in terms of total cholesterol levels) among women has lagged that of men. Similar findings have been previously reported (3) reaffirming that high-risk women have poorer management of dyslipidemia than in men, largely because they are less likely to receive guideline-recommended therapy such as high-intensity statin treatment (4,5). Thus, among survivors of a cardiovascular event, women are undertreated and are therefore likely to be at higher residual cardiovascular risk than men.

References

1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 2019; 139: e1082-e1143.
2. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 2020;41:111-188.
3. Peters SAE, Muntner P, Woodward M. Sex differences in the prevalence of, and trends in, cardiovascular risk factors, treatment, and control in the United States, 2001 to 2016. Circulation 2019;139:1025-1035.
4. Peters SAE, Colantonio LD, Zhao H, et al. Sex differences in high-intensity statin use following myocardial infarction in the United States. J Am Coll Cardiol 2018;71:1729-1737.
5. Rosenson RS, Farkouh ME, Mefford M et al. Trends in use of high-intensity statin therapy after myocardial infarction, 2011 to 2014. J Am Coll Cardiol 2017;69:2696-2706.

Key words

NHANES data; trends in lipid control; women versus men