The normal delay in age of onset of atherosclerotic cardiovascular disease (ASCVD) in women versus men may be shortened in individuals with familial hypercholesterolemia (FH), according to a study. Researchers found that both women and men with FH have an increased risk of premature ASCVD in the setting of hypertension (HTN) but risks from smoking and diabetes mellitus (DM) differ by sex. Furthermore, women with FH and premature ASCVD had higher on-treatment low-density lipoprotein cholesterol (LDL-C). The study team characterized sex-specific risk factor burdens and treatment outcomes in individuals with FH and premature ASCVD. The prevalence of premature ASCVD in more than 700 adults with FH from seven US-based lipid clinic practices was assessed retrospectively. A multivariate logistic mixed effects model with random study site effect and sex-specific analysis was used to determine the strongest predictors of premature ASCVD, and lipid treatment outcomes. Covariates included age, sex, DM, HTN, and current smoking. Researchers found that 98 of 280 men and 89 of 502 women had premature ASCVD. Women with premature ASCVD were older by an average of 3 years and had higher on-treatment total cholesterol. In men, the strongest predictors of premature ASCVD were HTN and DM. In women, the strongest predictors of premature ASCVD were HTN and smoking. Treated LDL-C was not a significant predictor of ASCVD in either men or women. “Aggressive treatment strategies are needed to reduce risk factor burdens and residual hyperlipidemia in these patients,” the study authors wrote.