Sex Disparities in Treatment, Lipid Level Targets in Familial Hypercholesterolemia

Sex disparities have been reported with respect to the treatment of and outcomes among patients with heterozygous familial hypercholesterolemia (HeFH). These findings were presented at the National Lipid Association Scientific Sessions, from June 2nd through 5th, in Scottsdale, AZ.

A longitudinal registry analysis was conducted in patients with HeFH at the McGill University Health Centre, located in Montréal, Québec, Canada. The researchers sought to identify sex inequalities in the treatment of and lipid target achievement levels among patients with HeFH. All data used in the study were obtained from the FH Canada Registry. This registry includes patients who are diagnosed as having “definite,” “probable,” or “possible” FH, based on the Simon-Broome criteria, the Dutch Lipid Criteria, or the Canadian FH definition.

HeFH has a prevalence of 1 per 311 individuals in the general population. If left untreated, FH can lead to premature atherosclerotic cardiovascular disease and death. With many barriers to the care for patients with FH reported, low rates of diagnosis and subsequent suboptimal treatment and outcomes exist.

A total of 127 women and 162 men were screened. Results of the study show a sex bias in patients with FH in favor of men, with respect to the use of lipid-lowering treatment intensity. Overall, among 116 men and 85 women, 94% and 86%, respectively, received lipid-lowering therapy. The use of high-intensity statins was reported among 74% of men compared with 35% of women, a difference that was statistically significant (P =.002). Further, statin intolerance was reported among 22% of men vs 40% of women (P =.02).

Guideline-recommended lipid level achievement also differed between men and women. Overall, among 110 male participants and 81 female participants, the average percent reduction in LDL-C was –62%±20% in men vs –51%±20% in women (P =.01). A change in LDL-C levels of 2.5 mmol/L or less from baseline to the most recent visit (follow-up) was reported among 55% of men vs 32% of women (P =.02). Further, a change in LDL-C levels of more than 4.0 mmol/L from baseline to follow-up was 7% in men compared with 21% in women (P =.01).

The researchers noted that identification of imbalances among patients with HeFH will permit the breaking down of the barriers to care in this population through educational initiatives and additional training.

Reference 

Guerin A, Iatan I, Ruel I, Ngufor L, Genest J. Sex disparities in treatment and outcomes of patients with familial hypercholesterolemia. Presented at: National Lipid Association Scientific Sessions; June 2-5, 2022; Scottsdale, AZ. Abstract #78.