In FH, women treated less aggressively than men
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In a cohort of patients with familial hypercholesterolemia, women were less likely than men to receive high-intensity treatment and reach LDL goals, according to data presented at the National Lipid Association Scientific Sessions.
“Although there are very effective treatments available for these patients, FH remains to be underrecognized and undertreated worldwide. In fact, in Canada, less than 15% of cases are diagnosed.” Amanda Guerin, BSc, Masters student at McGill University, trainee in the Cardiovascular Health Across the Lifespan Program at the research institute of the McGill University Health Centre and the 2022 Foundation of the NLA Donald Hunninghake Familial Hypercholesterolemia Abstract Award Winner, said during a presentation. “Many barriers to care in FH exist, which may result in the low diagnosis rates and unfavorable patient outcomes. Sex differences in diagnosis, treatment and outcomes have been described previously in cardiovascular diseases … Therefore, our research objective was to identify sex disparities in treatment and lipid level target achievement, in FH patients at the McGill University Health Center.”
Researchers utilized the FH Canada registry, which is comprised of 19 academic centers, to identify sex differences in the treatment and target lipid achievement among 289 patients with FH at the McGill University Health Centre (127 women). Change in LDL at baseline were compared to levels at most recent visit.
On average, women were a little older (49 vs. 45 years; P = .041); with lower Framingham Risk Score (4.5 vs. 6.7; P = .001); lower BMI (25.6 vs. 28.3 kg/m2; P < .001); and fewer prior CAD events (20.5% vs. 35.8%; P = .016) compared with men.
At baseline, among patients already on lipid-lowering therapy, women had greater mean total cholesterol (213.8 vs. 186.8 mg/dL; P = .01), HDL (53.8 vs. 44.5 mg/dL; P < .001) and apolipoprotein B (1.11 vs. 0.97 g/L; P < 007) compared with men.
Among women not on lipid-lowering therapy at baseline, mean total cholesterol and Apo B were comparable with men; however, mean HDL remained higher (56.5 vs. 44.5 mg/dL; P < .001) and triglycerides were lower (101.9 vs. 155 mg/dL; P < 007) compared with men not on lipid-lowering therapy.
By the time of their most recent visit, women with FH were less likely to be prescribed a high-intensity statin (35.3% vs. 74.1%; P = .002); were more often treated with a low-intensity statin (41.2% vs. 14.7%; P < .001); and were more likely to report statin intolerance (40% vs. 21.6%; P = .017) compared with men with FH.
Although both men and women with FH experienced LDL reduction at the time of their most recent visit, the change was larger for men compared with women, with an average reduction of 51.6% in women and 62.1%in men (P = .011).
The proportion of patients with certain LDL concentrations at follow-up was as follows:
- ≤ 2.5 mmol/L at follow-up (32.1% in women vs. 54.6% in men; P = .022);
- ≤ 3.0 mmol/L at follow-up (46.9% in women vs. 73.6% in men; P = .021); and
- > 4.0 mmol/L at follow-up (21% in women vs. 7.3% in men; P = .01)
“Importantly, we found that within our cohort, there is a sex bias in FH treatment intensity as well as lipid target achievement between men and women in favor of men,” Guerin said during the presentation. “Investigating why this occurs can help women with FH receive the best quality of care and treatment possible to further reduce premature ASCVD. As these results come from a single-center analysis, we are now in the process of doing a Canada-wide registry analysis to further confirm these findings.”
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Guerin A. Abstract 78. Presented at: National Lipid Association Scientific Sessions; June 2-5, 2022; Scottsdale, Arizona (hybrid meeting).
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