SEX DISPARITIES IN TREATMENT AND CLINICAL OUTCOMES OF FAMILIAL HYPERCHOLESTEROLEMIA

Abstract

BackgroundFamilial hypercholesterolemia (FH), a common inherited condition, is characterized by elevated low-density lipoprotein cholesterol (LDL-C). If left untreated, FH leads to the development of premature atherosclerotic cardiovascular disease (ASCVD) and death. Several barriers to care in FH exist, which can result in low rates of diagnosis and suboptimal treatment. Sex disparities have been identified as an important barrier to care in CVD, however their influence on treatment and lipid target achievement in FH remains to be explored.Methods and ResultsThe aim of this study was to identify sex disparities in treatment and lipid level targets achievement in FH patients. We first performed a systematic review by searching databases such as MEDLINE and Embase for peer-reviewed literature using validated strategies. Results were limited to studies published between September 1987 and May 2022. Studies were eligible if they determined sex-specific differences in treatment and CVD outcomes of FH patients. Out of 4981 articles screened, we identified 152 studies that met our eligibility criteria. Data extraction is currently ongoing. In parallel, we performed a longitudinal registry analysis of sex differences in treatment and lipid level achievement in FH patients at the McGill University Health Center. There were 127 females and 162 males from the McGill FH Registry included in the analysis. The mean age at the initial clinic visit was 49±17 years for females and 45±16 years for males (p=0.04). At the most recent clinic visit, only 35% of females were on high-intensity statins, compared to 74% of males (p=0.002). Interestingly, statin intolerance was reported in 40% of females and 22% of males (p=0.02). We then examined guideline-recommended lipid target achievement between both sexes. At baseline, males and females had similar mean LDL-C levels of 6.9±2.2 mmol/L and 6.7±1.6 mmol/L respectively. Despite this, at the most recent visit, 55% of males reached a target LDL-C of ≤ 2.5 mmol/L compared to just 32% of females (p=0.02). As well, from baseline to most recent visit, females reduced their LDL-C by 51%, whereas males lowered their LDL-C by 62% (p=0.01). Thus, fewer females are reaching appropriate guideline-based target LDL-C levels compared to males.ConclusionOur analysis reveals a sex bias in FH patients in favor of males in regard to treatment intensity and lipid level target achievement. Identifying these imbalances will allow us to break down these barriers in care through educational initiatives and additional training, to improve quality of life and life expectancy of individuals with FH. BackgroundFamilial hypercholesterolemia (FH), a common inherited condition, is characterized by elevated low-density lipoprotein cholesterol (LDL-C). If left untreated, FH leads to the development of premature atherosclerotic cardiovascular disease (ASCVD) and death. Several barriers to care in FH exist, which can result in low rates of diagnosis and suboptimal treatment. Sex disparities have been identified as an important barrier to care in CVD, however their influence on treatment and lipid target achievement in FH remains to be explored. Familial hypercholesterolemia (FH), a common inherited condition, is characterized by elevated low-density lipoprotein cholesterol (LDL-C). If left untreated, FH leads to the development of premature atherosclerotic cardiovascular disease (ASCVD) and death. Several barriers to care in FH exist, which can result in low rates of diagnosis and suboptimal treatment. Sex disparities have been identified as an important barrier to care in CVD, however their influence on treatment and lipid target achievement in FH remains to be explored. Methods and ResultsThe aim of this study was to identify sex disparities in treatment and lipid level targets achievement in FH patients. We first performed a systematic review by searching databases such as MEDLINE and Embase for peer-reviewed literature using validated strategies. Results were limited to studies published between September 1987 and May 2022. Studies were eligible if they determined sex-specific differences in treatment and CVD outcomes of FH patients. Out of 4981 articles screened, we identified 152 studies that met our eligibility criteria. Data extraction is currently ongoing. In parallel, we performed a longitudinal registry analysis of sex differences in treatment and lipid level achievement in FH patients at the McGill University Health Center. There were 127 females and 162 males from the McGill FH Registry included in the analysis. The mean age at the initial clinic visit was 49±17 years for females and 45±16 years for males (p=0.04). At the most recent clinic visit, only 35% of females were on high-intensity statins, compared to 74% of males (p=0.002). Interestingly, statin intolerance was reported in 40% of females and 22% of males (p=0.02). We then examined guideline-recommended lipid target achievement between both sexes. At baseline, males and females had similar mean LDL-C levels of 6.9±2.2 mmol/L and 6.7±1.6 mmol/L respectively. Despite this, at the most recent visit, 55% of males reached a target LDL-C of ≤ 2.5 mmol/L compared to just 32% of females (p=0.02). As well, from baseline to most recent visit, females reduced their LDL-C by 51%, whereas males lowered their LDL-C by 62% (p=0.01). Thus, fewer females are reaching appropriate guideline-based target LDL-C levels compared to males. The aim of this study was to identify sex disparities in treatment and lipid level targets achievement in FH patients. We first performed a systematic review by searching databases such as MEDLINE and Embase for peer-reviewed literature using validated strategies. Results were limited to studies published between September 1987 and May 2022. Studies were eligible if they determined sex-specific differences in treatment and CVD outcomes of FH patients. Out of 4981 articles screened, we identified 152 studies that met our eligibility criteria. Data extraction is currently ongoing. In parallel, we performed a longitudinal registry analysis of sex differences in treatment and lipid level achievement in FH patients at the McGill University Health Center. There were 127 females and 162 males from the McGill FH Registry included in the analysis. The mean age at the initial clinic visit was 49±17 years for females and 45±16 years for males (p=0.04). At the most recent clinic visit, only 35% of females were on high-intensity statins, compared to 74% of males (p=0.002). Interestingly, statin intolerance was reported in 40% of females and 22% of males (p=0.02). We then examined guideline-recommended lipid target achievement between both sexes. At baseline, males and females had similar mean LDL-C levels of 6.9±2.2 mmol/L and 6.7±1.6 mmol/L respectively. Despite this, at the most recent visit, 55% of males reached a target LDL-C of ≤ 2.5 mmol/L compared to just 32% of females (p=0.02). As well, from baseline to most recent visit, females reduced their LDL-C by 51%, whereas males lowered their LDL-C by 62% (p=0.01). Thus, fewer females are reaching appropriate guideline-based target LDL-C levels compared to males. ConclusionOur analysis reveals a sex bias in FH patients in favor of males in regard to treatment intensity and lipid level target achievement. Identifying these imbalances will allow us to break down these barriers in care through educational initiatives and additional training, to improve quality of life and life expectancy of individuals with FH. Our analysis reveals a sex bias in FH patients in favor of males in regard to treatment intensity and lipid level target achievement. Identifying these imbalances will allow us to break down these barriers in care through educational initiatives and additional training, to improve quality of life and life expectancy of individuals with FH.