What you need to know about these cholesterol-lowering medicines.
If you’ve been having trouble controlling your cholesterol levels, your doctor may have recommended that you take a statin drug. Statins lower LDL cholesterol—the so-called “unhealthy” or “bad” cholesterol because it helps to form the artery-clogging plaques that can lead to heart disease.
Several studies over the years have touted these drugs’ ability to prevent heart attacks, strokes, and heart-related deaths. That could be good news for women, who face a greater risk of dying from heart disease than from any other condition. But women are unique when it comes to matters of the heart, and the advantages of statins for us have not always been as clear as they are in men.
Other ways to lower cholesterol
Statin drugs aren’t the only way to control cholesterol. You can also try these cholesterol-lowering lifestyle changes:
Heart disease: Men vs. women
Heart disease is the leading killer of both men and women, but it evolves differently in the two sexes. “First of all, women tend to develop coronary artery disease at an older age than men, usually about 10 years later,” says William J. Kostis, clinical and research fellow in the Division of Cardiology at Massachusetts General Hospital. By then, women may already have co-existing heart risks such as diabetes and high blood pressure.
Women are also more likely than men to have damage to the tiny arteries of the heart—called coronary microvascular disease. This type of damage is harder to detect early with standard tests, and may delay treatment that can help reduce related symptoms.
LDL cholesterol can build up and form hard, sticky deposits called plaques in blood vessel walls. Over time, these plaques can harden the arteries and block blood flow through them, which is called atherosclerosis.
Looking for evidence
It’s been difficult to evaluate the effects of statin drugs in women, because studies done to test these drugs have been slow to recruit them. “It is the unfortunate truth that many large clinical trials still don’t have great representation of women,” says Dr. Kostis.
Until recently, most of the evidence on statin use in women came from heart disease studies that were made up mainly of men. Some studies included only 15 women for every 100 men. The lack of evidence may be why women aren’t prescribed statins as often as men, despite our high risk for heart disease.
In part because of the small numbers of female participants, evidence on the benefits of statins in women has been mixed. A 2004 analysis of 13 different studies found that statins reduced the risks of heart attack and heart disease deaths in women—but only in those who already had heart disease. Preventing heart attack in women with existing coronary artery disease is called secondary prevention. It differs from primary prevention, which stops coronary heart disease before it starts.
A much larger recent review that included 40,000 women found that statins prevent heart attacks and deaths from coronary artery disease in women just as well as they do in men, including women with risk factors for coronary disease who have not yet had a heart attack. According to the analysis of 18 clinical trials, led by Dr. Kostis, statins work in women with and without existing heart disease—and as a result are effective for both primary and secondary prevention.
Unique side-effect risks in women
Like any other medicine, statins can have side effects. Back in February, the FDA announced changes in the labeling of these drugs to include warnings about memory loss and confusion, increases in blood sugar levels, and—for lovastatin (Mevacor) in particular—interactions with drugs used to treat bacterial and fungal infections, as well as hepatitis C.
Some statin side effects—particularly a type of muscle pain called myalgia—may be more pronounced in women. “There is evidence from some studies that myalgias were reported somewhat more frequently in women than in men,” Dr. Kostis says.
You may also have heard that statins increase the risk for diabetes in postmenopausal women, evidence that was based on a study of more than 150,000 women published in the January Archives of Internal Medicine. However, because this was only an observational study, it’s hard to tell whether statins actually cause diabetes, or if women with high cholesterol are just more susceptible to getting diabetes. A 2010 analysis in The Lancet also found that statins slightly increase diabetes risk, but it concluded that the heart benefits from these drugs far outweigh the small increase in the risk of developing diabetes.
Should you take statins?
Statins can be an important component of heart disease prevention in women, just as they are in men. “If a woman is at high risk for coronary heart disease, and especially if she’s already had a cardiovascular event, these drugs can be very helpful in reducing the risk that she’ll have another cardiovascular event,” Dr. Kostis says.
Weighing the side effects of these drugs against their potential benefits is an important part of making the decision to take statins, he says. You and your doctor should take into consideration your heart disease risk factors, including your blood pressure and cholesterol level, weight, family history of heart disease, and whether you smoke.
Know that even if you take statins, they can’t protect your heart alone. “They should be part of a comprehensive plan that includes diet and exercise, weight control, blood pressure and blood sugar control, and avoidance of risky behaviors, such as smoking,” Dr. Kostis says.