Key result
Women with heterozygous familial hypercholesterolemia were diagnosed 5 years later than men (51 vs 46 years), despite men having a 64% higher risk of major cardiac events (HR 1.64).
Why the study?
Recent data suggest significant sex differences in diagnosis and treatment of familial hypercholesterolemia, but no prior data existed regarding this issue among Japanese patients.
Does male sex compared to female sex affect the risk of major adverse cardiac events in Japanese patients with heterozygous familial hypercholesterolemia?
Does male sex compared to female sex affect the risk of major adverse cardiac events in Japanese patients with heterozygous familial hypercholesterolemia?
In Japanese patients with heterozygous familial hypercholesterolemia, men have a higher risk of MACE despite lower LDL-C levels, while women are diagnosed significantly later in life.
Background Recent data suggest that there is a significant sex difference in diagnosis and treatments for patients with familial hypercholesterolemia (FH). No prior data exist regarding this issue among Japanese FH. Methods Japanese patients with clinically diagnosed heterozygous FH (HeFH) (N=1,273, male/female=614/659) at our university hospital were assessed. We compared variables, including those associated with diagnosis and treatments between male and female. Cox proportional hazards models were used to assess factors associated with major adverse cardiac event (MACEs), including cardiovascular death and any coronary events among both sexes. Results The median follow-up period was 10.9 years. During the follow-up period, 142 MACEs were observed. We found that the age of diagnosis as HeFH was significantly older in women compared with men (51 years vs. 46 years, respectively, P<0.001). Male sex was significantly associated with MACEs (hazard ratio (HR): 1.64; 95% confidence interval (CI): 1.14–2.14; P<0.001), although LDL cholesterol level at baseline as well as at the follow-up were lower than those of female. No significant differences were observed in terms of factors associated with MACEs in sexes. Conclusions There are some sex differences in diagnosis and treatments for Japanese HeFH patients. Despite their protective property, we need to diagnose and treat female patients with HeFH much earlier.
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Kojima et al. (2025) studied this question. Women with heterozygous familial hypercholesterolemia were diagnosed 5 years later than men (51 vs 46 years), despite men having a 64% higher risk of major cardiac events (HR 1.64).
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