Letters to the Editor
In Reply
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From birth, girls have higher cholesterol concentrations than boys; this continues throughout adolescence. In men, the age dependent rise in cholesterol starts about 10 years earlier than in women, but the time-lagged rise in women is stronger and sustained after the menopause. Over the course of life this means a greater cumulative cholesterol burden in women with non-familial hypercholesterolemia than in men (details were recently summarized by the European Atherosclerosis Society). We emphatically agree with Dr Burkhardt that more clinical trials should be carried out in women. However, no scientific doubt exists about the causal importance of cholesterol for atherosclerosis in women and the resultant opportunities for prevention.
The hypothesis of preventing atherosclerosis by means of hormone therapies has been repeatedly studied, but to date, all robust randomized trials with clinical endpoints in women (and men) were neutral or negative. In particular the large Women’s Health Study showed that treating women with estrogens did not lead to a reduction in cardiovascular events. For this reason, hormone therapy is not licensed for this indication.
DOI: 10.3238/arztebl.m2024.0182
Prof. Dr. med. Ulrich Laufs
Klinik und Poliklinik für Kardiologie
Universitätsklinikum Leipzig
Ulrich.Laufs@medizin.uni-leipzig.de
Prof. Dr. Ioanna Gouni-Berthold
Poliklinik für Endokrinologie, Diabetologie und Präventivmedizin
Universitätsklinik Köln
Conflict of interest statement
IGB received lecture fees, reimbursement of travel expense and congress fees as well as honoraria for Advisory Board activities and/or research support from Amgen, Daiichi-Sankyo, Novartis, Sanofi, Synlab, Amarin, and Ultragenyx. She is Deputy Chairperson of DACH and a member of the IAS Executive Committee.
UL received lecture fees, reimbursement of travel expense and congress fees as well as honoraria for Advisory Board activities and/or research support from Amgen, AstraZeneca, Bayer, Boehringer, Daiichi-Sankyo, Lilly, MSD, Novartis, NovoNordisk, Pfizer, Roche, Sanofi, and Synlab. He fulfills various functions in the DGK, DACH, EAS, and ESC.
| 1. | Gouni-Berthold I, Laufs U: Special aspects of cholesterol metabolism in women. Dtsch Arztebl Int 2024; 121: 401–6. CrossRef MEDLINE PubMed Central VOLLTEXT |
