Do Statins Work in Women?

While statins have become a mainstay of cardiac risk reduction over the past decade or two, there remains a controversy over just how beneficial statins are in women.

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Why Are Statins So Important?

The statin drugs are are considered so important in cardiovascular medicine (and therefore, tend to be so controversial) because they are the only cholesterol-lowering drugs that have been shown to substantially and reliably reduce the risk of heart attacks, strokes, and death in high-risk patients.

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In fact, it now seems clear that statins do far more than merely lower your cholesterol levels -- they have an anti-inflammatory effect; they help to prevent abnormal blood clotting; they help to stabilize the arterial plaques whose rupture so often leads to heart attacks and strokes; and they have other beneficial effects as well.

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The unique benefits of statin drugs in preventing cardiovascular problems, documented in several important clinical trials, makes most doctors very enthusiastic about using these drugs in their patients whose cardiovascular risk is elevated.

What's The Controversy About Statins in Women?

The controversy arises because it has not yet been proven that statins significantly reduce cardiovascular risk in women who do not yet have proven heart disease.

Here is what we know: In women who have had prior heart attacks or acute coronary syndrome -- that is, in women who have coronary artery disease (CAD) that has already led to significant medical problems -- statins are effective in reducing subsequent cardiac events, just as as they are in men.

But studies that have looked at the ability of statins to reduce serious cardiovascular events in people without known CAD, but whose cardiac risk factors place them in a "moderate risk" category, have not yet demonstrated a significant benefit with statins in women. And so, some experts have concluded, statins should not be used in women who are merely at an increased risk for cardiovascular disease.

Other experts point out that clinical trials studying the use of statins in both men and women at moderate risk have shown an overall reduction in cardiovascular events, suggesting that both men and women benefited from the drugs. But in these trials, not enough women were enrolled to enable a statistically accurate measurement of whether that risk was significantly reduced in the women alone.

So Should Statins Be Used In Women?

There is little controversy about whether statins should be given to women who have had heart attacks or acute coronary syndrome. They should.

Whether they should be used in women who are "merely" at moderate risk for cardiovascular disease is where the controversy remains. The experts who insist that no therapy should be used until there is firm, statistical proof of benefit think statins should not be used in these women.

But other experts point out that current clinical evidence does not indicate that statins are ineffective in these women; it merely indicates that not enough data are available to either prove or disprove a benefit. And since statins clearly do work well in women with more advanced forms of heart disease, there is every reason to think they also work in less advanced forms. Until definitive proof (one way or the other) does become available, such experts say, these women should be given the benefit of the doubt and should be offered statin therapy.

Conclusion

So that's the controversy, and that's the state of our knowledge.

If you are a woman with overt CAD, you should be taking a statin just as any man would with your medical condition.

But if you are a woman at moderate risk for CAD, you will need to discuss with your doctor the relative risks and benefits of statin therapy, and decide what is the best course in your individual case. Because you are a woman, you need to be aware that the benefits of statin therapy in your case are certainly less clear-cut than they would be for a man -- and may turn out not to be present at all. And further, you need to take into account that some of the side effects of statins might be more likely in women -- in particular, the risk of developing diabetes. Finally, you will need to discuss with your doctor the possibility that you can substantially reduce your risk without any medication by engaging in an aggressive program of lifestyle changes.

• Read about reducing your risk of cardiac disease.

Keep in mind, however, that if statins were not so uniquely beneficial, and if they did not work at so many levels (over and above mere cholesterol-lowering) to prevent cardiovascular events, there would not be any controversy here at all.

_Sources:

_{Davignon, J. Beneficial cardiovascular pleiotropic effects of statins. Circulation 2004; 109:III39.}

_{Nissen, SE. High-dose statins in acute coronary syndromes. Not just lipid levels. JAMA 2004; 292:1365.}