目标:在家族性高胆固醇血症(FH)中,女性动脉粥样硬化性心血管疾病比没有FH的女性早20年。这项研究的目的是描述脂蛋白单采(LA)的差异,最后的治疗选择,就功效而言,两种性别之间的安全性和临床结果。
方法:分析了31名受试者的性别相关差异,这些受试者接受了FH的LA治疗,但在最大限度的降脂治疗中未达到LDL-胆固醇和/或Lp(a)目标值。此外,在68名受试者中调查了与主要心血管事件(MACE)发生时间的性别相关差异,至少有一年的随访。
结果:在目前接受LA治疗的31例未达到LDL-胆固醇和/或Lp(a)目标值的患者中,尽管LA治疗前的血脂状况较差,但没有记录到合并症的差异(男性与男性的LDL-C77±60mg/dl女性为128±105mg/dl;p0.025)和更长的平均单采间期(男性为17±4天女性19±5天;p0.012)与男性相比,女性报告。此外,与男人相比,发现从第一次心血管事件到LA开始之间的时间,以及洛杉矶开始时的年龄,女性明显高于男性(p分别为0.027和0.007)。
结论:FH受试者的性别差异不仅影响诊断和治疗,而且影响对治疗本身的不同反应。
OBJECTIVE: In Familial Hypercholesterolemia (FH), female atherosclerotic cardiovascular disease occurs 20 years earlier than in women without FH. The aim of this study is to describe the differences in lipoprotein apheresis (LA), a last therapeutic option, in terms of efficacy, safety and clinical outcomes between the two sexes.
METHODS: Sex related differences were analysed in 31 subjects in on LA treatment with FH and not achieving LDL-cholesterol and/or Lp(a) target values on maximum lipid-lowering therapies. Moreover, sex related differences in time to major cardiovascular event (MACE) was investigated in 68 subjects, with at least one year of follow-up.
RESULTS: Among the 31 patients currently undergoing LA treatment who did not achieve LDL-cholesterol and/or Lp(a) target values, no differences in comorbidity were recorded despite a worse pre-LA treatment lipid profile (LDL-C 77 ± 60 mg/dl in males vs. 128 ± 105 mg/dl in females; p 0.025) and a longer mean inter-apheresis interval (17 ± 4 days in males vs. 19 ± 5 days in females; p 0.012) reported in females compared to males. Additionally, in comparison with men, it was found that the time between the first cardiovascular event and the beginning of LA, as well as the age at the beginning of LA, were significantly higher in females than in males (p 0.027 and 0.007, respectively).
CONCLUSIONS: Sex differences in FH subjects not only affect the diagnosis and treatment but also influence varied responses to the treatment itself.