Key result
Five years after acute coronary syndrome, females were more likely to not use statins (OR 1.61) and less likely to have combination lipid-lowering therapy compared to males.
Why the study?
Long-term control of cardiovascular risk factors after ACS is essential to prevent recurrence, but the extent of management across sex and familial hypercholesterolemia status was unknown.
Does patient sex and familial hypercholesterolemia status affect long-term lipid-lowering therapy and LDL-c target attainment 5 years after acute coronary syndrome?
Cohort (n=3,139)
Yes
Does patient sex and familial hypercholesterolemia status affect long-term lipid-lowering therapy and LDL-c target attainment 5 years after acute coronary syndrome?
Odds Ratio: 1.61 (95% CI 1.28–2.03)
Five years after acute coronary syndrome, females and patients with familial hypercholesterolemia are significantly less likely to achieve guideline-recommended LDL-c targets, highlighting a need for more intensive lipid-lowering therapy in these high-risk groups.
BACKGROUND Long-term control of cardiovascular risk factors after acute coronary syndrome (ACS) is the cornerstone for preventing recurrence. We investigated the extent of cardiovascular risk factor management in males and females with and without familial hypercholesterolemia (FH) 5 years after ACS. METHODS We studied patients hospitalized for ACS between 2009 and 2017 in a Swiss multicenter prospective cohort study. FH was defined based on clinical criteria from the Dutch Lipid Clinic Network and Simon Broome definitions. Five years post-ACS, we assessed low-density lipoprotein-cholesterol (LDL-c) levels, lipid-lowering therapy (LLT), and other cardiovascular risk factors, comparing males to females with and without FH using generalized estimating equations. RESULTS A total of 3139 patients were included; mean age was 61.4 years (SD, 12.1), 620 (19.8%) were female, and 747 (23.5%) had possible FH. Compared with males at 5-years post-ACS, females were more likely to not use statins (odds ratio, 1.61 [95% CI, 1.28-2.03]) and less likely to have combination LLT (odds ratio, 0.72 [95% CI, 0.55-0.93]), without difference between patients with FH and without FH. Females in both FH and non-FH groups less frequently reached LDL-c values ≤1.8 mmol/L (odds ratio, 0.78 [95% CI, 0.78-0.93]). Overall, patients with FH were more frequently on high-dose statins compared with patients without FH (51.0% versus 42.9%; P=0.001) and presented more frequently with a combination of 2 or more LLT compared with patients without FH (33.8% versus 17.7%; P<0.001), but less frequently reached LDL-c targets of ≤1.8 mmol/L (33.5% versus 44.3%; P<0.001) or ≤2.6 mmol/L (70.2% versus 78.1%; P=0.001). CONCLUSIONS Five years after ACS, females had less intensive LLT and were less likely to reach target LDL-c levels than males, regardless of FH status. Males and females with FH had less optimal control of LDL-c despite more frequently taking high-dose statins or combination LLT compared with patients without FH. Long-term management of patients with ACS and FH, especially females, warrants optimization.
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Krasieva et al. (2024) conducted a cohort in Acute Coronary Syndrome (n=3,139). Female sex vs. Male sex was evaluated on Not using statins at 5 years post-ACS (OR 1.61, 95% CI 1.28-2.03). Five years after acute coronary syndrome, females were more likely to not use statins (OR 1.61) and less likely to have combination lipid-lowering therapy compared to males.
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