Abstract
Background and aimsThe UK Simon Broome (SB) familial hypercholesterolaemia (FH) register previously reported 3-fold higher standardised mortality ratio for cardiovascular disease (CVD) in women compared to men from 2009 to 2015. Here we examined sex differences in CVD morbidity in FH by national linkage of the SB register with Hospital Episode Statistics (HES). MethodsOf 3553 FH individuals in the SB register (aged 20–79 years at registration), 2988 (52.5% women) had linked HES records. Standardised Morbidity Ratios (SMbR) compared to an age and sex-matched UK general practice population were calculated [95% confidence intervals] for first CVD hospitalisation in HES (a composite of coronary heart disease (CHD), myocardial infarction (MI), stable or unstable angina, stroke, TIA, peripheral vascular disease (PVD), heart failure, coronary revascularisation interventions). ResultsAt registration, men had significantly (p < 0.001) higher prevalence of previous CHD (24.8% vs 17.6%), previous MI (13.2% vs 6.3%), and were commenced on lipid-lowering treatment at a younger age than women (37.5 years vs 42.3 years). The SMbR for composite CVD was 6.83 (6.33–7.37) in men and 7.55 (6.99–8.15) in women. In individuals aged 30–50 years, SMbR in women was 50% higher than in men (15.04 [12.98–17.42] vs 10.03 [9.01–11.17]). In individuals >50 years, SMbR was 33% higher in women than men (6.11 [5.57–6.70] vs 4.59 [4.08–5.15]). ConclusionsExcess CVD morbidity due to FH remains markedly elevated in women at all ages, but especially those aged 30–50 years. This highlights the need for earlier diagnosis and optimisation of lipid-lowering risk factor management for all FH patients, with particular attention to young women with FH.
Highlights
Familial hypercholesterolaemia is an autosomal dominant disorder characterised by lifelong elevated plasma levels of low-density lipo protein (LDL) cholesterol, which when untreated, leads to increased risk of coronary heart disease (CHD) and premature death [1]
Previous studies of the UK Simon Broome register examined changes in CHD mortality in familial hypercholesterolaemia (FH) patients both before and after the routine use of statins, and found that while there was a significant reduction in CHD mortality in men over time, excess mortality persisted in women [7], such that excess CHD mortality was 3-fold higher in women than men in the period from 2009 to 2015 [7]
While significantly more women than men had a history of hyperten sion, the prevalence of type 2 diabetes was similar in men and women, and low overall, was similar to the prevalence of type 2 diabetes in the UK general population during the period of recruitment of the patient cohort [12]
Summary
Familial hypercholesterolaemia is an autosomal dominant disorder characterised by lifelong elevated plasma levels of low-density lipo protein (LDL) cholesterol, which when untreated, leads to increased risk of coronary heart disease (CHD) and premature death [1]. Previous studies of the UK Simon Broome register examined changes in CHD mortality in FH patients both before and after the routine use of statins, and found that while there was a significant reduction in CHD mortality in men over time, excess mortality persisted in women [7], such that excess CHD mortality was 3-fold higher in women than men in the period from 2009 to 2015 [7] These previous studies were limited to only coronary disease mortality outcomes in this patient population. Conclusions: Excess CVD morbidity due to FH remains markedly elevated in women at all ages, but especially those aged 30–50 years This highlights the need for earlier diagnosis and optimisation of lipid-lowering risk factor management for all FH patients, with particular attention to young women with FH
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