Women with familial hypercholesterolemia phenotype are undertreated and poorly controlled compared to men

Area of Science:

• Cardiology
• Genetics
• Public Health

Background:

• Familial hypercholesterolemia (FH) is a prevalent autosomal dominant disorder, significantly increasing the risk of early coronary heart disease (CHD).
• Understanding sex-based differences in the management and outcomes of FH is crucial for optimizing cardiovascular disease prevention strategies.

Purpose of the Study:

• To compare the effectiveness of lipid-lowering therapy (LLT) and treatment adherence between men and women diagnosed with Familial Hypercholesterolemia-Phenotype (FH-P).
• To identify sex-specific disparities in achieving lipid level goals in both primary and secondary prevention among FH-P patients.

Main Methods:

• Analysis of a large cohort (over 2.5 million individuals) from the Catalan primary care database, identifying 14,699 subjects with FH-P based on LDL-c levels.
• Comparison of LLT intensity, medication possession ratio (MPR) for adherence, and achievement of LDL-c goals stratified by sex and prevention setting (primary vs. secondary).

Main Results:

• Women with FH-P were less likely to be treated with high-intensity LLT compared to men in both primary and secondary prevention.
• Adherence to LLT was lower in women, particularly those over 55 years old in secondary prevention.
• A significantly higher percentage of both women and men with FH-P failed to reach target LDL-c levels (<1.81 mmol/L), with women showing a slightly lower probability of achieving their goals.

Conclusions:

• Women with FH-P experience significant sex-based disparities in LLT intensity and adherence, leading to suboptimal lipid management.
• These findings underscore the need for sex-specific approaches in managing FH-P to improve cardiovascular outcomes and reduce the burden of early CHD.