Cardiovascular diseases (CVD) are still the leading cause of mortality, accounting for 31% of all deaths worldwide. Most CVD can be prevented by acting on modifiable risk factors [1]; however, the evidence shows that targets for detecting and controlling these risk factors have not been fully achieved. Dyslipidemia is one of the main cardiovascular risk factors. Although its prevalence exceeds 50% in Europe [2] (specifically, it ranges from 31% to 50% in Spain [3]), it is the least considered and treated risk factor, and despite modest gains, its control is still insufficient [4,5]. The recent IBERICAN study [5] shows that only 25.8% of patients with dyslipidemia are well controlled.

Even though CVD is the main cause of death in women [6,7], it is still perceived as a man’s disease [8,9]. Women and men generally share the same cardiovascular risk factors, but these have differential effects according to gender. For example, in women metabolic syndrome is the most important risk factor for developing ischemic heart disease at an unusually young age [10]; smoking is more likely to cause coronary ischemia in women than in men [11]; and the onset of hypertension and dyslipidemia is later in women, but also more poorly controlled [12,13].

Since the turn of the century, understanding has grown around the need to focus more on sex- and gender-related differences in the prevention, diagnosis, and treatment of CVD [14]. In 2007, the American Heart Association published evidence-based guidelines focused on the primary prevention of CVD in women, which were later updated in 2011 as effectiveness-based guidelines [15]. Despite the improvements that this guidance promoted, evidence indicates that healthcare delivery and outcomes still differ between women and men. Particularly worrisome are findings that women with a similar level of CVD risk as men are less likely to receive treatment or preventive recommendations [14,16]. Furthermore, women are less likely to receive treatment intensification or achieve the optimal treatment effect [17,18]. When these differences systematically lead to gender inequalities related to established roles and stereotypes, this can be a determinant of differences in health outcomes [19].

Broadly speaking, the poor control of dyslipidemia in both sexes may be related, on the one hand, to limitations in the predictive capacity of the SCORE scale to detect cardiovascular disease [20], and on the other hand, to clinical inertia. Phillips was the first to define this concept in 2001 [21] as “the failure of physicians to initiate or intensify treatment when it was indicated”. Subsequently, the term has been reformulated as therapeutic inertia. Some studies on this topic, such as the one published by Chou AF et al. [22] in 2007, report low control of low-density lipoprotein (LDL) cholesterol in all patients, but especially in women, suggesting a less intensive cholesterol treatment in women, that is, greater therapeutic inertia in this group. Gil-Guillén et al.’s [23] working group differentiated between “diagnostic inertia,” or the failure to initiate treatment, and “therapeutic inertia,” or the failure to intensify it. In a systematic review on the concept of therapeutic inertia in arterial hypertension in primary care [24], review authors recognized the new definition of diagnostic inertia for the first time. Clinical inertia is frequent in pathologies such as arterial hypertension [25] or dyslipidemia; in a 2014 cross-sectional study, investigators observed that 38% of all cholesterol alterations and 17.7% of alterations in high-density lipoprotein (HDL) cholesterol were not diagnosed [26]. Regarding the factors associated with clinical inertia, Meador et al. [27] found that younger or obese people may be at higher risk of having their hypertension remain undiagnosed. Studies exploring the clinical inertia for dyslipidemia are scarce, Palazon et al. [26] observed that type-2 diabetes, non-smoking, previous coronary heart disease, blood pressure values, and body mass index were factors associated with diagnostic inertia for dyslipidemia. There is a lack of research analyzing specifically the gender association with clinical inertia.

Until the second half of the 20th century, women were not included in experimental studies, so much of the current knowledge about the main diseases affecting population health comes from studies carried out exclusively in men, with their results also applied to women [28]. This gender bias in research and the scant consideration of sex-related differences in clinical trials undermine the certainty of the evidence produced and may have negative consequences for health. In 2015, Vázquez et al. [29] identified a triple gender bias in the health system, while Ruíz-Cantero MT et al. [30] highlighted the importance of analyzing diagnostic criteria and normal cutoff points from a gender perspective, especially for diseases associated principally with men. In 2018, Aggarwal et al. [31] concluded that risk factors for ischemic heart disease should be stratified by sex. Although recent research shows detrimental gender biases in terms of diagnostic delay and errors in women [32], to our knowledge no study has assessed differences in the application of diagnostic criteria for dyslipidemia between men and women.

2. Insightful Analysis