Study Reveals Gender Disparities in Long-Term Lipid Management After ACS for FH Patients

Kristina Krasieva, MD
Credit: LinkedIn

An analysis of data from more than 3100 patients with a history of acute coronary syndrome is shedding light on disparities in management among men and women 5 years after their event.

Using data from a multicenter prospective study conducted in Switzerland, results of the analysis suggest women had less intestine lipid-lowering therapy and were less likely to reach their LDL-C targets, with this trend persistent regardless of background familial hypercholesterolemia (FH).¹

“Five years after acute coronary syndrome, sex disparities are present in FH management, with females less likely to take statins or have a combination of lipid-lowering therapies,” wrote investigators.¹

Led by Kristina Krasieva, MD, of Center for Primary Care and Public Health at the University of Lausanne, the current study was to better understand contemporary trends in the management of men and women after an acute coronary syndrome with and without FH. To do so, investigators designed their study as an analysis of data from the Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort.¹

A large prospective cohort study pooling of patients from 4 university centers in Switzerland, SPUM-ACS enrolled patients from 2007 through 2017 and was designed to further the medical community’s understanding of acute coronary syndromes with the aim of improving patient outcomes. With data from more than 6000 patients, the cohort has become a data source for a bevy of additional analyses.^1,2,3

The primary outcomes of interest for the current analysis were the LDL-C levels, lipid-lowering therapy, and other cardiovascular risk factors comparatively among males and females with and without FH. Investigators pointed out this was calculated using generalized estimating equations and with adjustment 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.¹

For the purpose of analysis, the Dutch Lipid Clinic Network score and the Simon Broome criteria were used to define clinical FH in patients at baseline. Of note, investigators excluded patients who died during the study or who did not have follow-up data available at 5 years post-ACS.¹

Overall, 5287 of the 6359 participants in the SPUM-ACS cohort were deemed eligible for inclusion in the analysis. Of these, 59.4% had data available from a 5-year follow-up visit, yielded a final sample of 3139 individuals for inclusion. At baseline, this cohort had a mean age of 61.4 years, 19.8% were female, and 737 had FH.¹

Results of the analysis revealed females were more likely to not use statins (odds ratio [OR], 1.61; 95% CI, 1.28 to 2.03) and less likely to have combination lipid-lowering therapy(OR, 0.72; 95% CI, 0.55 to 0.93) than their male counterparts at 5-years post-ACS, without difference between patients with FH and without FH.

Relative to their counterparts without FH, patients with FH were more likely to be on high-intensity statins (51.0% vs 42.9%; P = .001) and present with a combination of 2 or more lipid-lowering therapies (33.8% vs 17.7%; P <.001). Despite this, patients with FH remained less likely 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).¹

Investigators noted multiple limitations within their study to consider when interpreting their findings. These limitations included diagnosis of FH without genetic tests, information at the 5-year follow-up visits was based on patient knowledge of their medications, and only having access to a small sample size of patients receiving PCSK9 inhibitors at follow-up.¹

“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],” investigators added.¹

References:

1. ^{Krasieva K, Gencer B, Locatelli I, et al. Association Between Patient Sex and Familial Hypercholesterolemia and Long-Term Cardiovascular Risk Factor Management 5 Years After Acute Coronary Syndrome. Circ Cardiovasc Qual Outcomes. Published online June 20, 2024. doi:10.1161/CIRCOUTCOMES.123.010790}
2. ^{Bruno F, Wenzl FA, De Filippo O, et al. Safety and effectiveness of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: insights from the SPUM-ACS study. Eur Heart J Cardiovasc Pharmacother. Published online April 11, 2024. doi:10.1093/ehjcvp/pvae024}
3. ^{Matter MA, Candreva A, Stähli BE, et al. Higher 1-year mortality on rest days in patients with acute coronary syndromes and decompensated heart failure-A SPUM-ACS sub-study. Catheter Cardiovasc Interv. 2024;103(2):286-294. doi:10.1002/ccd.30938}