Atherosclerosis · Nov 2026
Sex-specific clinical and psychosocial characteristics among individuals with familial hypercholesterolemia reporting side-effects of lipid-lowering therapy
By Uduma ASØ, Sverre E, Munkhaugen J et al.
Background and Aims Symptoms attributed to lipid-lowering therapy (LLT) may affect adherence. We explored sex-specific clinical and psychosocial characteristics associated with self-perceived side-effects of LLT in individuals with familial hypercholesterolemia (FH). Methods Adults (N=2709) with FH, identified through a quality registry, were invited to a cross-sectional study. Participants completed a self-report questionnaire covering side-effects, use of LLT, muscle symptoms, pain treatment and psychosocial factors. Results Among 613 participants (22.6% response rate), median age was 55 (IQR; 43, 65) years and 56% were women. Forty-five (13%) women and 47 (17%) men reported self-perceived side-effects of LLT. In both sexes, self-perceived side-effects were associated with significantly higher perceived sensitivity to medicines, more concerns about LLT, higher ratings of muscle symptoms and pain intensity, and lower self-rated general health. Among women, those with side-effects were more frequently living alone (38% vs 20%, p=0.017) and reported more musculoskeletal complaints (62% vs 37%, p=0.004). Among men, those reporting side-effects had higher median LDL-cholesterol (2.5 vs 2.1, p=0.032), and higher prevalence of depressive symptoms (30% vs 11%, p=0.003) and insomnia (60% vs 41%, p=0.045). Adjustment for age, cardiovascular comorbidity and BMI made only minor changes in the effect estimates in logistic regression analyses. Conclusions Participants with FH and self-perceived side-effects reported a significant symptom burden and concerns about the use of LLT. Women with side-effects more frequently reported musculoskeletal complaints and living alone, whereas psychological distress and insomnia were more prominent among men reporting side-effects. Individual assessments of sex-specific characteristics may be valuable for improving follow-up.