Most adults with FH do not reach guideline-recommended cholesterol targets
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Key takeaways:
- Only 26.9% of women and 28.9% of men with familial hypercholesterolemia reach LDL targets.
- Women with FH are less likely to be prescribed high-dose statins or combination therapy than men.
About 75% of adults with heterozygous familial hypercholesterolemia do not meet guideline-recommended LDL treatment targets, whereas women with familial hypercholesterolemia are less likely than men to be appropriately treated, data show.
“Only a minority of men and women with familial hypercholesterolemia (FH) are currently at target level LDL and the percentage of women is even lower than men,” Jeanine Roeters van Lennep, MD, PhD, an internist, associate professor and head of the vascular medicine clinic at Erasmus MC University Center, Rotterdam, the Netherlands, told Healio. “Women started with higher LDL levels and were less often treated with high-dose statins or combination therapy.”
Data were derived from Schreuder MM, et al. Atherosclerosis. 2023;doi:10.1016/j.atherosclerosis.2023.03.022.
In a cross-sectional, observational study, Roeters van Lennep and colleagues analyzed data from 3,178 patients with heterozygous FH (53.9% women) from five hospitals in the Netherlands and Norway. The median age of patients was 48 years; 94% were treated with statin therapy and 58% were treated with ezetimibe. Researchers assessed information about lipid-lowering therapies, lipid levels and reasons for not being at LDL treatment targets using electronic medical records.
The findings were published in Atherosclerosis.
For women, the median LDL before treatment and on-treatment was 6.2 mmol/L and 6 mmol/L, respectively (P = .005), whereas the median LDL before treatment and on-treatment for men was 3 mmol/L and 2.8 mmol/L, respectively (P < .001).
Within the cohort, just 26.9% of women and 28.9% of men reached LDL targets. Among those with CVD, 17.2% of women and 25.8% of men reached LDL targets.
In assessing lipid-lowering therapies, researchers found that women were less often prescribed high-intensity statins and ezetimibe. The most commonly reported reasons for not achieving the LDL target were insufficient effect of maximum lipid-lowering therapy (women, 17.3%; men, 24.3%) and adverse effects (women, 15.2%; men, 8.6%).
“We know that compared with the risk of the general population, women with FH have an even higher risk for CVD compared with men,” Roeters van Lennep told Healio. “One reason may be that women are treated less aggressively with lipid-lowering treatments. We also looked into the reasons why women and men were not on target and found that women reported more side effects and more often stopped lipid-lowering therapies. It is very important for clinicians to stress the importance of lipid-lowering treatments for women.”
Roeters van Lennep said researchers must assess ways to better implement guidelines so treating physicians will treat men and especially women with FH to target.
“It is also important to study how we can reassure patients, especially women, that statins are safe,” Roeters van Lennep said.
For more information:
Jeanine Roeters van Lennep, MD, PhD, can be reached at j.roetersvanlennep@erasmusmc.nl; Twitter: @j_rvl.
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