Sex Disparities in Long-Term Lipid Management: Daily Dose

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On June 21, 2024, we reported on findings from a study published in Circulation: Cardiovascular Quality and Outcomes that examined the association between sex and LDL-C, lipid-lowering therapy, and other cardiovascular (CV) risk factor management 5 years after acute coronary syndrome (ACS) in persons with and without familial hypercholesterolemia (FH).

The study

Researchers analyzed data from the Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort, a pooling of individuals hospitalized for ACS from 4 university centers in Switzerland. SPUM-ACS enrolled patients from 2007 through 2017 and includes data for more than 6000 individuals.

The diagnosis of FH was made at study baseline using the Dutch Lipid Clinic Network score and the Simon Broome criteria. Covariable adjustment was made for family history of premature CAD, which was defined as a history of myocardial infarction or percutaneous coronary intervention in first-degree male family members before 55 years of age and first-degree female family members before 60 years of age.

The findings

Of the 5287 SPUM-ACS cohort members eligible for the analysis, 59.4% had data available from a 5-year follow-up visit, yielding a final sample 3139 individuals.

Investigators reported that women were more likely than men to not use statins (OR, 1.61; 95% CI, 1.28 to 2.03) and less likely to be treated with combination lipid-lowering therapy (OR, 0.72; 95% CI, 0.55 to 0.93) than men at 5-years post-ACS. Women also were less likely to reach target LDL-C goals at the 5-year follow up compared with men. There were no differences in likelihood between participants with FH and without FH. The researchers also found that the probability of not being on statin therapy increased significantly between discharge and 1-year post-ACS, again with no difference between those with and without HF.

When the researchers compared CV risk management among participants with and without HF, the former were more likely to be on high-intensity statins (51.0% vs 42.9%; P = .001) and also more likely to be receiving a combination of 2 or more lipid-lowering therapies (33.8% vs 17.7%; P <.001). Yet even though lipid lowering therapy was more intensive among individuals with FH, investigators found they remained less likely than those without FH to reach LDL-C target goals of 1.8 mmol/L or less (33.5% vs 44.3%; P <.001) or 2.6 mmol/L or less (70.2% vs 78.1%; P = .001).

Authors' comment

“With the large panel of lipid-lowering drugs currently available, more stringent management, such as an increase in the prescription of combination [lipid-lowering therapy], could lead to higher rates of LDL-C target attainment and reduced recurrent cardiovascular events in males and females, both with and without FH, after [acute coronary syndrome]."

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