Do Women Get Equal Benefit from Statins?
Statin drugs might not benefit women as much as they do men, a new research analysis suggests. But experts writing a related editorial found fault with the conclusions. The new study pooled the results of 11 prior studies. They included a total of 43,191 people. Only one-fifth of those were women. Among women and men, taking statins reduced the risk of a heart attack 27%. Men taking statins also had a lower risk of repeat stroke than those taking placebo pills. Their risk of death from all causes also was lower. But for women, the difference in risk for stroke and all-cause death was smaller. Researchers said it was small enough that it could have been the result of chance. The journal Archives of Internal Medicine published the study. Writers of an editorial in the same journal said the analysis left out too many relevant studies. They said other research reviews have found that statins help men and women equally. HealthDay News wrote about the new research review June 25.
What Is the Doctor's Reaction?
Many studies done in the last 20 years show that cholesterol-lowering drugs called statins save people's lives. Some have brought into question whether the drugs are as effective for women as they are for men. This new study sought to address that question.
The authors pooled data from 11 published studies. This is called a meta-analysis. The analysis looked at whether statins have an equal effect on women and men. Everyone in the study had a previous event such as a heart attack or stroke, or was high-risk for other reasons.
The authors concluded that statins lower cholesterol equally in men and women. Their analysis also found that statins worked equally well in men and women to prevent repeat heart attacks. They concluded that statins reduced strokes and early death for men, but not for women.
A commentary on the article disagrees with this important finding. It argues that statins work equally well for men and for women. The commentary writers question whether the research analysis included enough studies to reach its conclusions.
I found several things quite interesting in the results of this study. First, the pooled studies included relatively few women compared with men. Often, women were about 20% of the study groups. The women also were more likely to have high blood pressure than men with the same medical issues. They were less likely to be taking an aspirin. Finally, women in the study were older. Some articles suggested that certain statins might prevent stroke and heart disease better than others in women.
In conclusion, the article is clear in saying that these drugs can help to prevent repeat heart attack in women who have had previous heart troubles. It is less able to tell us whether or not statins prevent stroke and other causes of death.
What Changes Can I Make Now?
If you are a woman who has had a heart attack or you care about a woman with heart disease, prevention of new events is really important. Women who have had heart attacks can do many things to ensure their ongoing good health.
Quit smoking. Yesterday!
Exercise and lose weight.
Aim to keep your total cholesterol lower than 200 and your LDL ("bad cholesterol") less than 100. In many cases, it should be far less than 100. Most people require drugs, usually statins, to achieve this.
If you are not taking an aspirin, talk to your doctor about whether you should be.
If you've had a stent put into an artery near the heart, ask your doctor about drugs to help prevent blood clots.
If you have diabetes, aim to keep your blood sugar as normal as possible. Your goal for hemoglobin A1C should be less than 7%.
Depending on your personal history, you might benefit from several other types of medicine. These could include beta-blockers and ACE inhibitors.
If you haven't had a heart attack, lifestyle changes can help prevent heart disease. For some women, medicine might also help. Talk to your doctor about lowering your cholesterol, for example. Learn more about prevention for women at any age from the American Heart Association.
What Can I Expect Looking to the Future?
While this study answers some questions, it brings up a lot more. I will be looking for good studies that help us to know if statins help prevent stroke. I will also be looking for studies that include more women. Finally, doctors must make an effort to ensure that women with heart disease are treated as appropriately as men with heart disease. I'll be working on this in my practice and hope others will as well.