Women With Heterozygous FH Less Likely to Receive Treatment

There are gender differences among patients with heterozygous familial hypercholesterolemia (HeFH) in terms of when the disease is diagnosed, how it is treated, and the levels of low-density lipoprotein (LDL) cholesterol attained, suggest data from a large multinational registry.

Moreover, less than 40% of children with HeFH are receiving lipid-lowering medication, and those who are typically have LDL cholesterol levels similar to untreated children.

The research was presented at the European Atherosclerosis Society 2020 Virtual Congress on October 6, held online this year due to the COVID-19 pandemic.

For the first analysis, researchers looked at data from the European Atherosclerosis Society (EAS) Familial Hypercholesterolemia Studies Collaboration (FHSC) Global Registry, which includes almost 17,000 men and 20,000 women with probable or confirmed HeFH.

Lead author Antonio J. Vallejo-Vaz, PhD, EAS FHSC Coordinating Centre, Imperial College London, England, said that the data show “there are differences in FH characteristics and management by gender.”

“Despite being an inherited condition, FH is identified late, with women being identified slightly later than men, and presenting with slightly higher LDL cholesterol.”

He noted that there are also gender differences in the prevalence of cardiovascular (CV) risk factors and disease, with women having approximately half the prevalence of coronary artery disease (CAD) than that of men.

“LDL cholesterol goal attainment is low at the time of registry entry in both genders, with women less frequently on goal and on intensification of therapy,” Vallejo-Vaz added.

He therefore called for “greater attention on the early identification and management of FH,” and that addresses the differences between men and women.

In a separate analysis, Kanika Dharmayat, MPH, also from the EAS FHSC Coordinating Centre, and colleagues looked at data on almost 8000 children with HeFH, finding that less than 40% were being treated with lipid-lowering medications, and only around 10% were receiving statins.

She also noted that “untreated LDL cholesterol levels in children are lower on average than adults, and this could have implications for LDL cholesterol levels that trigger an FH clinical diagnosis and/or subsequent genetic testing.”

Dharmayat highlighted that, even when treated, there was no change in LDL cholesterol levels among children aged less than 9 years, which “could be due to under treatment, as suggested by the limited proportion of children receiving lipid-lowering medications and…the small proportion receiving statins.”

Mary P. McGowan, MD, chief medical officer at the The FH Foundation, Pasadena, California, told theheart.org | Medscape Cardiology that the gender differences seen in adults are “very consistent” with the data they have published from their US database.

She said that “women are less aggressively treated” than men, but on the other hand “women do have fewer risk factors, so there’s a lot to tease out. Are they less aggressively treated because they’re viewed as being somewhat less at risk?”

McGowan noted, however, that “the treatment is not great for either men or women, or children, and it just shows that FH needs to be recognized more commonly and needs to be treated more aggressively.”

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