If a fibrate is neces- sary in a patient being treated with a statin, it is safer to use fenofibrate than gemfibrozil because of lower risk of severe myopathy.S4.5.2-16 Severe or life-threatening hypertriglyceridemia during preg- nancy is best managed in consultation with a lipid 4.5.3. Issues Specific to Women Recommendations for Issues Specific to Women Referenced studies that support recommendations are summarized in Online Data Supplements 33 to 35. COR LOE Recommendations I B-NR Clinicians should consider conditions specific to women, such as premature menopause (age <40 years) and history of pregnancy- associated disorders (hypertension, preeclampsia, gestational diabetes mellitus, small-for-gestational-age infants, preterm deliveries), when discussing lifestyle intervention and the potential for benefit of I C-LD Women of childbearing age who are treated with statin therapy and are sexually active should be counseled to use a reliable form of I C-LD Women of childbearing age with hypercholesterolemia who plan to become pregnant should stop the statin 1 to 2 months before pregnancy is attempted, or if they become pregnant while on a statin, should have the statin stopped as soon as the pregnancy is discovered.S4.5.3-7 S4.5.3-12 Synopsis Although atherosclerosis typically occurs later in wom- en than in men, CVD remains the leading cause of death in women. Statins clearly reduce ASCVD events in women as well as in men with ASCVD. The 2015 meta-analysis by the CTT Collaboration showed no heterogeneity by gender for the risk of major vascular events with statin therapy in participants with a history of vascular disease.S4.5.3-13 A history of certain pregnan- cy-related conditions and premature menopause (age <40 years) have been associated with increased ASCVD risk. However, current best practice emphasizes that statins should not be taken during pregnancy. 