Before bempedoic acid (BA) initiation, women had higher median LDL-C and less intensive LLT; BA or BA+ezetimibe reduced LDL-C by 31-38% in women vs 22-30% in men at 8 weeks.
Does bempedoic acid or bempedoic acid + ezetimibe improve LDL-C levels and reduce treatment disparities between men and women with hypercholesterolaemia?
Women with hypercholesterolemia are undertreated with lipid-lowering therapies compared to men, but initiation of bempedoic acid leads to greater relative LDL-C reductions in women, reducing the treatment disparity.
Absolute Event Rate: 0% vs 0%
Abstract Background Disparities between men and women in cardiovascular (CV) care have been described in clinical practice, with women often less likely to receive lipid-lowering therapy (LLT) compared with men. Further real-world data are needed to better understand these differences. Purpose To evaluate differences in LLT use and low-density lipoprotein cholesterol (LDL-C) levels between men and women from four European countries participating in the MILOS study. Methods The MILOS study is an ongoing, European, prospective, non-interventional study evaluating the effectiveness and safety of bempedoic acid (BA) or the BA + ezetimibe (EZE) fixed-dose combination (FDC). Adult patients with hypercholesterolaemia or mixed dyslipidaemia were recruited from October 2022 to February 2024. An interim analysis stratified by sex was performed in patients from Austria, Belgium, Italy and the United Kingdom to evaluate LLT use before initiation of BA or BA + EZE FDC, and the corresponding changes in LDL-C at 8 weeks of follow-up. Results Baseline data were analysed from 2121 patients (42% women) across Austria (n=200; 51% women), Belgium (n=375; 35% women), Italy (n=1310; 41% women) and the United Kingdom (n=236; 54% women). At baseline, women had a slightly higher mean age (66.6 years) compared with men (65.1 years). Of 2107 patients (42% women) with baseline data on CV risk classification by the investigator, 25% to 38% of women were classified as high CV risk and 37% to 59% very high risk, compared with 13% to 46% and 26% to 80%, respectively, of men. Across all countries, a greater proportion of women (35 to 55%) compared with men (18% to 45%) were not receiving any LLT before BA or BA + EZE FDC initiation (Table). Among patients on LLT, women predominantly received monotherapy, whereas men were more likely to receive combination therapy, except in the United Kingdom, where a higher proportion of men were receiving monotherapy (Table). Among the 1953 patients (42% women) with LDL-C data available before BA or BA + EZE FDC initiation, median LDL-C was higher in women than men (Figure). Among the 1111 patients (42% women) with 8-week LDL-C data, the median relative reduction was greater across countries in women (−31% to −38%) than men (−22% to −30%; Figure). Conclusions In the MILOS study, women had higher median LDL-C levels and were less likely to receive intensive LLT compared with men before BA initiation. The addition of BA or BA + EZE FDC, with or without other LLTs, led to greater relative LDL-C reductions at 8 weeks in women compared with men. As a result, absolute LDL-C levels between men and women became more comparable, indicating a reduction in the treatment disparity. These findings underscore the importance of implementing targeted strategies to address the observed discrepancies and ensure equitable treatment for women, ultimately improving cardiovascular outcomes across genders.
Gouni-Berthold et al. (Sat,) reported a other. Before bempedoic acid (BA) initiation, women had higher median LDL-C and less intensive LLT; BA or BA+ezetimibe reduced LDL-C by 31-38% in women vs 22-30% in men at 8 weeks.