Sex differences in the perception of cardiovascular risk in familial hypercholesterolemia

•Females with FH are undertreated compared with males. •Sex differences in perception of FH as a disease was assessed in patients with FH. •We found no differences in the perception of ASCVD risk between males and females. •Females expressed more concerns about high LDL-C and safety of statins. •Physician's perception of ASCVD risk in males and females with FH is to be examined. BACKGROUND Familial hypercholesterolemia (FH), a common genetic condition, is characterized by elevated LDL-C and premature atherosclerotic cardiovascular disease (ASCVD). Recent data indicate an undertreatment of females with FH. OBJECTIVE To characterize the role of sex in the perception of FH, its associated ASCVD risk and treatment. METHODS A survey investigating for sex differences in the perception of FH was sent to 1073 patients with FH using a cross sectional study design. RESULTS A total of 412 patients (51.9 % male) responded to the survey; mean age was 56.2 ± 14.4 years. There was a higher proportion of males with ASCVD than females (41.5% vs. 16.5 %, respectively, p<0.001). Analyses of the survey responses showed that a majority of both males and females agreed that their risk of ASCVD is higher than healthy individuals of same age (70.8% vs. 74.7 %, respectively, p = 0.434). Females were more concerned about having high LDL-C levels (67.5% vs. 56.5 % in males, p = 0.024), especially those in secondary prevention programs. As for treatment of FH, approximately 75 % of both sex groups considered statins to be efficient in reducing the risk of myocardial infarction, but less than half of the females considered statins to be safe (44.8% vs. 60.0 % in males, p = 0.003). No major sex differences were noted regarding the influence of the doctor in their understanding of FH as a disease. CONCLUSION Overall, both males and females with FH were well informed about FH, although females were more concerned about having high LDL-C levels and they feared the safety of statins. Familial hypercholesterolemia (FH), a common genetic condition, is characterized by elevated LDL-C and premature atherosclerotic cardiovascular disease (ASCVD). Recent data indicate an undertreatment of females with FH. To characterize the role of sex in the perception of FH, its associated ASCVD risk and treatment. A survey investigating for sex differences in the perception of FH was sent to 1073 patients with FH using a cross sectional study design. A total of 412 patients (51.9 % male) responded to the survey; mean age was 56.2 ± 14.4 years. There was a higher proportion of males with ASCVD than females (41.5% vs. 16.5 %, respectively, p<0.001). Analyses of the survey responses showed that a majority of both males and females agreed that their risk of ASCVD is higher than healthy individuals of same age (70.8% vs. 74.7 %, respectively, p = 0.434). Females were more concerned about having high LDL-C levels (67.5% vs. 56.5 % in males, p = 0.024), especially those in secondary prevention programs. As for treatment of FH, approximately 75 % of both sex groups considered statins to be efficient in reducing the risk of myocardial infarction, but less than half of the females considered statins to be safe (44.8% vs. 60.0 % in males, p = 0.003). No major sex differences were noted regarding the influence of the doctor in their understanding of FH as a disease. Overall, both males and females with FH were well informed about FH, although females were more concerned about having high LDL-C levels and they feared the safety of statins.