November 22, 2017
2 min read

Racial, sex disparities persist in familial hypercholesterolemia

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Women, black and Asian patients were less likely to be treated for familial hypercholesterolemia compared with men and white patients, according to an analysis published in Atherosclerosis.

“The findings of this study from the CASCADE FH registry add to our knowledge about why patients with familial hypercholesterolemia (FH) may be undertreated,” Zahid Ahmad, MD, assistant professor at UT Southwestern Medical Center in Dallas and site principal investigator for the CASCADE FH registry, told Cardiology Today. “In the U.S., health disparities — both sex and ethic/racial — seem to be a factor.”

CASCADE FH registry data

Stephen M. Amrock, MD, resident physician at Oregon Health and Science University in Portland, and colleagues analyzed data from 3,167 patients (61% women) from the CASCADE FH registry with either heterozygous or homozygous FH who had at least one office visit at a lipid clinic in the past 5 years. Patients with any secondary cause of hypercholesterolemia were excluded.

Outcomes of interest included a decrease in LDL from highest pretreatment levels of at least 50%, achieved LDL of less than 100 mg/dL, treatment with any statin and treatment with a high-intensity statin.

Of the patients in the analysis, 79% were white, 8.2% were black, 4.9% were Hispanic, 2.9% Asian and 4.9% were another race or ethnicity. The median pretreatment LDL was 256 mg/dL.

Women were less likely to achieve an LDL level less than 100 mg/dL (OR = 0.68; 95% CI, 0.57-0.82) or a reduction of at least 50% (OR = 0.79; 95% CI, 0.65-0.96) compared with men after adjusting for covariates including pre-existing atherosclerotic CVD.

Disparities in statin therapy

Only 70.2% of women were on any statin therapy vs. 80.3% of men (OR = 0.6; 95% CI, 0.5-0.73) after adjusting for factors such as atherosclerotic CVD. Adjusted data also showed that high-intensity statin therapy was lower in women (48.9%) compared with men (64.6%; OR = 0.6; 95% CI, 0.49-0.72).

Black patients (OR = 0.49; 95% CI, 0.32-0.74) and Asian patients (OR = 0.47; 95% CI, 0.24-0.94) were less likely to achieve an LDL less than 100 mg/dL compared with white patients. An LDL reduction of at least 50% was less likely to be achieved by Asian (OR = 0.56; 95% CI, 0.32-0.98) and black patients (OR = 0.62; 95% CI, 0.43-0.9) vs. white patients.

“Health care providers should be aware of these disparities, so when seeing FH patients, they can make sure to treat appropriately,” Ahmad said. “For example, young women are often not treated with statins due to biases against treating premenopausal women. However, a young woman with FH has an elevated heart attack risk, so statin therapy is warranted.”

Individuals with familial hypercholesterolemia are at an extremely high risk for heart disease during the prime of their lives if left untreated, and yet they continue to be vastly underdiagnosed,” Katherine Wilemon, founder and CEO of the FH Foundation, said in a press release. “The national CASCADE FH registry demonstrates that women, blacks and Asians living with FH are treated later and less effectively than their white male counterparts. We need to rigorously study these groups and develop evidence-based strategies to drive improved care for all individuals with this life-threatening genetic condition.” – by Darlene Dobkowski

Disclosures: The CASCADE FH registry was supported by Amgen, AstraZeneca, Pfizer, Regeneron and Sanofi. Amrock reports no relevant financial disclosures. Ahmad reports he received research grants from Regeneron, honoraria from Genzyme and Sanofi and serves as a consultant/advisory board member for Genzyme. Please see the study for all other authors’ relevant financial disclosures.