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Association Between Patient Sex and Familial Hypercholesterolemia and Long-Term Cardiovascular Risk Factor Management
Kristina Krasieva1, Baris Gencer2,3,4, Isabella Locatelli1
1Center for Primary Care and Public Health (Unisanté), University of Lausanne, Switzerland (K.K., I.L., D.N.).
Insights
Five years after acute coronary syndrome (ACS), females received less intensive lipid-lowering therapy and were less likely to reach target LDL-c levels than males, irrespective of familial hypercholesterolemia (FH) status. Management requires optimization, particularly for females with FH.
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Long-term cardiovascular risk factor control is crucial for preventing recurrent events after acute coronary syndrome (ACS).
- Investigating cardiovascular risk factor management in relation to sex and familial hypercholesterolemia (FH) status 5 years post-ACS is essential.
Purpose of the Study:
- To assess the extent of cardiovascular risk factor management in males and females with and without FH 5 years after ACS.
- To compare lipid-lowering therapy (LLT) and low-density lipoprotein-cholesterol (LDL-c) control between sexes and FH groups post-ACS.
Main Methods:
- A Swiss multicenter prospective cohort study included 3139 patients hospitalized for ACS (2009-2017).
- Familial hypercholesterolemia (FH) was defined using established clinical criteria.
- Generalized estimating equations were used to compare outcomes (LLT, LDL-c levels) between males and females, with and without FH, 5 years post-ACS.
Main Results:
- Females were less likely to use statins and combination LLT, and less likely to achieve target LDL-c levels (≤1.8 mmol/L) compared to males, irrespective of FH status.
- Patients with FH received more high-dose statins and combination LLT but were less likely to reach LDL-c targets (≤1.8 and ≤2.6 mmol/L) compared to those without FH.
- Overall, females consistently showed less intensive LLT and poorer LDL-c control compared to males.
Conclusions:
- Females experience less intensive lipid-lowering therapy and suboptimal LDL-c control 5 years post-ACS compared to males, regardless of FH status.
- Patients with FH, despite more aggressive treatment, exhibit less optimal LDL-c control.
- Optimization of long-term cardiovascular risk management is warranted for all ACS patients, with a particular focus on females and those with FH.
Background:
Long-term control of cardiovascular risk factors after acute coronary syndrome (ACS) is the cornerstone for preventing recurrence. We investigated the extent of cardiovascular risk factor management in males and females with and without familial hypercholesterolemia (FH) 5 years after ACS.
Methods:
We studied patients hospitalized for ACS between 2009 and 2017 in a Swiss multicenter prospective cohort study. FH was defined based on clinical criteria from the Dutch Lipid Clinic Network and Simon Broome definitions. Five years post-ACS, we assessed low-density lipoprotein-cholesterol (LDL-c) levels, lipid-lowering therapy (LLT), and other cardiovascular risk factors, comparing males to females with and without FH using generalized estimating equations.
Results:
A total of 3139 patients were included; mean age was 61.4 years (SD, 12.1), 620 (19.8%) were female, and 747 (23.5%) had possible FH. Compared with males at 5-years post-ACS, females were more likely to not use statins (odds ratio, 1.61 [95% CI, 1.28-2.03]) and less likely to have combination LLT (odds ratio, 0.72 [95% CI, 0.55-0.93]), without difference between patients with FH and without FH. Females in both FH and non-FH groups less frequently reached LDL-c values ≤1.8 mmol/L (odds ratio, 0.78 [95% CI, 0.78-0.93]). Overall, patients with FH were more frequently on high-dose statins compared with patients without FH (51.0% versus 42.9%; P=0.001) and presented more frequently with a combination of 2 or more LLT compared with patients without FH (33.8% versus 17.7%; P<0.001), but less frequently reached LDL-c targets of ≤1.8 mmol/L (33.5% versus 44.3%; P<0.001) or ≤2.6 mmol/L (70.2% versus 78.1%; P=0.001).
Conclusions:
Five years after ACS, females had less intensive LLT and were less likely to reach target LDL-c levels than males, regardless of FH status. Males and females with FH had less optimal control of LDL-c despite more frequently taking high-dose statins or combination LLT compared with patients without FH. Long-term management of patients with ACS and FH, especially females, warrants optimization.
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