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Cited by 229Lipoproteins and Cardiovascular HealthSex and Gender in HealthcareDiabetes, Cardiovascular Risks, and Lipoproteins

Women, lipids, and atherosclerotic cardiovascular disease: a call to action from the European Atherosclerosis Society

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Roeters van Lennep, Jeanine E, Tokgözoğlu, Lale S, Badimon, Lina, Dumanski, Sandra M, Gulati, Martha, Hess, Connie N, Holven, Kirsten B, Kavousi, Maryam +8 more·2023·European Heart Journal
DOI 10.1093/eurheartj/ehad472PMC PMC10576616
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Abstract

Cardiovascular disease is the leading cause of death in women and men globally, with most due to atherosclerotic cardiovascular disease (ASCVD). Despite progress during the last 30 years, ASCVD mortality is now increasing, with the fastest relative increase in middle-aged women. Missed or delayed diagnosis and undertreatment do not fully explain this burden of disease. Sex-specific factors, such as hypertensive disorders of pregnancy, premature menopause (especially primary ovarian insufficiency), and polycystic ovary syndrome are also relevant, with good evidence that these are associated with greater cardiovascular risk. This position statement from the European Atherosclerosis Society focuses on these factors, as well as sex-specific effects on lipids, including lipoprotein(a), over the life course in women which impact ASCVD risk. Women are also disproportionately impacted (in relative terms) by diabetes, chronic kidney disease, and auto-immune inflammatory disease. All these effects are compounded by sociocultural components related to gender. This panel stresses the need to identify and treat modifiable cardiovascular risk factors earlier in women, especially for those at risk due to sex-specific conditions, to reduce the unacceptably high burden of ASCVD in women.

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  • Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk.

    “Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk (144-146).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2025 (2025) · cites this paper as [145]

    The 'Call to action' section says high-risk women are less likely than men to receive statins. The 'Familial hypercholesterolaemia' section reports lower LDL-C goal attainment and treatment interruptions around pregnancy in women with FH. These passages do not establish both findings for all individuals of childbearing potential or assess LDL-C goal attainment across cardiovascular-risk levels. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk.

    “Individuals of childbearing potential are less likely to be treated with statins or achieve their LDL cholesterol goals based on their cardiovascular risk (138–140).”

    From 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [139]

    The “Call to action” section says women at high cardiovascular risk are less likely than men to be prescribed statins. The “Familial hypercholesterolaemia” section reports lower LDL-C goal attainment and interrupted statin treatment around pregnancy, but specifically for women with FH. The paper does not establish both outcomes for all individuals of childbearing potential according to cardiovascular risk. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Authors
Roeters van Lennep, J. E., Tokgözoğlu, L. S., Badimon, L., Dumanski, S. M., Gulati, M., Hess, C. N., Holven, K. B., Kavousi, M., Kayıkçıoğlu, M., Lutgens, E., Michos, E. D., Prescott, E., Stock, J. K., Tybjaerg-Hansen, A., Wermer, M. J. H., & Benn, M.
Affiliations
  • Department of Internal Medicine, Cardiovascular Institute, Erasmus Medical Center , Dr. Molewaterplein 40, 3015 GD Rotterdam , The Netherlands
  • Hacettepe University (TR)
  • Cardiovascular Science Program-ICCC, IR-Hospital de la Santa Creu I Santa Pau, Ciber CV, Autonomous University of Barcelona , Barcelona , Spain
  • University of Calgary (CA)
  • Cedars-Sinai Medical Center (US)
  • University of Colorado Anschutz (US)
  • Oslo University Hospital (NO)
  • Erasmus MC (NL)
  • Ege University (TR)
  • Mayo Clinic (US)
  • Johns Hopkins University (US)
  • Bispebjerg Hospital (DK)
  • European Atherosclerosis Society (SE)
  • Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, The Copenhagen General Population Study, Copenhagen University Hospital-Herlev and Gentofte Hospital, and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
  • University Medical Center Groningen (NL)
  • University of Copenhagen (DK)
ORCID
Venue
European Heart Journal
Publisher
Oxford University Press (OUP)
Published
2023-08-23
Volume
44
Issue
39
Pages
4157-4173
ISSN
  • 0195-668X (ISSN-L)
  • 1522-9645
DOI
10.1093/eurheartj/ehad472
PMC
PMC10576616
OpenAlex
W4386090741
Cited by
229
References
227
Citations by year
2026: 53 · 2025: 113 · 2024: 54 · 2023: 9
FWCI
61.36
Type
journal article
Language
en
Open access
Licence
Locations
  • European Heart Journal (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc)
  • Leiden Repository (Leiden University) (submittedVersion, cc-by-nc)
  • Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc)
  • NORA - Norwegian Open Research Archives (submittedVersion, cc-by-nc)
Funders
  • Amgen
  • Pfizer
  • AstraZeneca
  • Sanofi
  • Regeneron Pharmaceuticals
  • Amarin Corporation
  • Mylan
  • Amryt Pharma
  • European Commission
  • European Society of Cardiology
  • Servier
  • Silence Therapeutics
  • Esperion Therapeutics
  • National Heart, Lung, and Blood Institute
  • Daiichi Sankyo Europe
Topics
  • Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
atherosclerotic cardiovascular disease, women, sex differences, sex-specific risk factors, lipids, lipoprotein(a), hypertensive disorders of pregnancy, premature menopause, primary ovarian insufficiency, polycystic ovary syndrome, diabetes mellitus, chronic kidney disease, autoimmune inflammatory disease, cardiovascular risk, gender disparities, cardiovascular risk reduction
MeSH terms
Cardiovascular Diseases, Female, Humans, Male, Middle Aged, Pregnancy, Risk Factors, Lipoprotein(a), Atherosclerosis

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