Sex- and gender specific analysis of patients with and without reported statin intolerance referred to a specialized outpatient lipid clinic

Background: Lowering LDL-cholesterol is a fundamental purpose for both primary and secondary prevention of atherosclerotic cardiovascular diseases. Our study aims to analyze potential sex and gender disparities regarding the tolerability and effectiveness of lipid-lowering therapy in patients with and without reported statin intolerance, who are being treated at a lipid-outpatient clinic.

Methods: From 2017 to 2022, n=1062 patients (n=612 men, n=450 women) at high-risk were referred to our lipid-outpatient clinic because of difficulties in lipid control by primary healthcare providers. The main therapeutic objective was to optimize lipid-lowering therapy according to current treatment guidelines. 

Results: Patients presented with high LDL-C baseline levels (4.97±1.81 mmol/l (192±70 mg/dL) in men and 5.46±2.04 mmol/l (211±79 mg/dL) in women). Intolerance towards statins was reported more frequently by women (48.2%) than by men (38.9%, p=0.004). LDL-C continuously decreased with individual treatment adjustments across follow-up visits. In total, treatment goals (LDL<1.4 mmol/l (<55 mg/dl) or <1.8 mmol/l (<70 mg/dl)) were accomplished in 75.8% of men and 55.5% of women after the last follow-up visit (p<0.0001). In men, these data are almost similar in subjects with statin intolerance. In contrast, treatment goals were reached less frequently in women with statin intolerance compared to women tolerant to statin therapy.

Conclusion: Even if treated in a specialized lipid clinic, women are less likely to reach their target LDL-C than men, particularly when statin intolerant. Nevertheless, a large proportion of patients with statin intolerance can be successfully treated using oral combination and PCSK9-inhibitor therapy. However, ongoing follow-up care to monitor progress and to adjust treatment plans is necessary to reach this goal.