Female sex predictive of LDL-C goal underachievement

Among high-risk individuals, women are less likely than men to achieve the guideline-recommended low-density lipoprotein cholesterol (LDL-C) target, as shown in a study.

For the study, researchers used health administrative and laboratory data from seven local health districts in Tuscany, Italy. A total of 174,200 residents (mean age 72.2 years, 55 percent men) were identified. Of these individuals, 76,734 (44.0 percent) had type 2 diabetes mellitus (T2DM), 65,878 (37.8 percent) had a history of major adverse cardiac or cerebrovascular event (MACCE), and 31,588 (18.3 percent) had both T2DM and a history of MACCE.

The study outcome was the number of individuals with optimal levels of LDL-C (<55 mg/dl for those with MACCE and <70 mg/dl for those with T2DM without MACCE). Optimal LDL-C levels were documented in 20,274 individuals (11.6 percent). Most individuals were not receiving any lipid-lowering therapy (n=89,840, 51.6 percent), with men more likely than women to be on therapy.

LDL-C target attainment was more common among individuals receiving lipid-lowering therapy (18.6 percent vs 5.1 percent, p<0.001), those with T2DM (13.5 percent in the T2DM group and 15 percent in the T2DM and MACCE group vs 6.9 percent in the MACCE group, p<0.001), and men (14.0 percent vs 8.8 percent in women, p<0.001)

In multivariable Poisson regression analysis, female sex emerged as an independent predictor of LDL-C target underachievement among individuals with MACCE with or without T2DM (adjusted incidence rate ratio [IRR], 0.58; p<0.001). This result was consistent among individuals who were not receiving lipid-lowering therapies (adjusted IRR, 0.56; p<0.001).

The findings underscore the need for action to implement education for clinicians and patients and to establish clinical care pathways for high-risk patients, with a special focus on women.