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Review
. 2023 Nov;25(11):861-868.
doi: 10.1007/s11883-023-01155-6. Epub 2023 Oct 10.

Sex Differences in Familial Hypercholesterolemia

Marianne Klevmoen  1   2 , Janneke W C M Mulder  3 , Jeanine E Roeters van Lennep  3 , Kirsten B Holven  4   5
Affiliations
Review

Sex Differences in Familial Hypercholesterolemia

Marianne Klevmoen et al. Curr Atheroscler Rep. 2023 Nov.

Abstract

Purpose of review: This review aims to summarize the existing research on sex differences in familial hypercholesterolemia (FH) across the lifespan.

Recent findings: From childhood onward, total- and low-density lipoprotein cholesterol (LDL-C) levels in girls are higher than those in boys with FH. By the age of 30 years, women with FH have a higher LDL-C burden than men. In adulthood, women are diagnosed later than men, receive less lipid-lowering treatment, and consequently have higher LDL-C levels. An excessive atherosclerotic cardiovascular disease risk is reported in young female compared to male FH patients. The periods of pregnancy and breastfeeding contribute to treatment loss and increased cholesterol burden. Earlier initiation of treatment, especially in girls with FH, and lifelong treatment during all life stages are important. Future research should aim to recruit both women and men, report sex-specific data, and investigate the impact of the female life course on cardiovascular outcomes. Future guidelines should include sex-specific aspects.

Keywords: Breastfeeding; Cardiovascular disease; Cholesterol; Familial hypercholesterolemia; Pregnancy; Sex differences.

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Conflict of interest statement

Dr. van Lennep reports research grants from Dutch Heart Foundation, The Netherlands Organisation for Health Research and Development, Novartis. She has received payment of honoraria for lectures and presentations by several non-pharmaceutical industry companies. She serves as Executive Board member of European Atherosclerosis Society, Member of Scientific Advisory Board Dutch Heart Foundation. Dr. Holven has received grants and/or payment of honoraria for lectures and presentations from Mills, Amgen, and Sanofi. The other authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Future directions for considering sex differences in FH in clinic and research. FH: familial hypercholesterolemia
See this image and copyright information in PMC

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