What is the impact of lipid-lowering therapies on cardiovascular disease incidence among women with familial hypercholesterolaemia: A systematic review.

BACKGROUND: Familial hypercholesterolaemia (FH) is a genetic condition that significantly increases cardiovascular disease (CVD) risk, particularly in women. Lipid-lowering therapies (LLTs), such as statins and PCSK9 inhibitors, play a crucial role in reducing low-density lipoprotein cholesterol (LDL-C) and preventing CVD. However, women with FH often face disparities in diagnosis, treatment and outcomes. OBJECTIVES: To assess the effectiveness of LLT in reducing CVD incidence among women with FH and identify gaps in current treatment practices. DESIGN: Systematic review. DATA SOURCES AND METHODS: A comprehensive literature search was conducted in December 2024 across PubMed, EMBASE, Web of Science and CINAHL, guided by the PICO framework. Thirteen studies met the inclusion criteria; six were rated high quality using the Evidence-Based Librarianship tool. Due to heterogeneity in study design and outcomes, a narrative synthesis was performed. RESULTS: LLT, particularly statins, consistently reduced LDL-C levels and CVD incidence in women with FH. PCSK9 inhibitors and combination therapies offered additional benefit in high-risk cases. Up to an 80% relative risk reduction was observed in women who initiated early and sustained therapy. However, several studies reported that women were less likely to receive intensive LLT, had a delayed diagnosis and were 32% less likely than men to reach LDL-C targets. Data on premenopausal and menopausal women remain limited. CONCLUSION: LLTs are effective in reducing CVD risk in women with FH, yet treatment disparities persist. Addressing barriers such as adherence, hormonal influences and access to advanced therapies is essential. Personalised, gender-specific strategies are needed to close care gaps and improve outcomes for this high-risk population.