Statins: Are They Effective and Safe in Preventing Women's Heart Disease?

Controversies in Medicine
Sharon Reimold, M.D.

Sharon Reimold, M.D., is an expert in cardiac care and cardiac imaging who has read and interpreted more than 60,000 echocardiograms during her career. She is also an expert on gender differences in cardiac disease, with a large portion of her practice devoted to treating women. Dr. Reimold earned her medical degree from Washington University in St. Louis and completed a fellowship in cardiovascular disease at Brigham and Women’s Hospital in Boston. To schedule an appointment, call 214-645-8300.

By Sharon Reimold, M.D.
Professor of Internal Medicine UT Southwestern Medical Center

Since the late 1980s, millions of men and women have taken cholesterol-lowering medications called statins to either prevent or reduce their risk of heart attack or stroke. Known commercially by names such as Crestor, Lipitor, and Zocor, statins reduce LDL or “bad” cholesterol in the blood, thereby preventing the accumulation of additional dangerous plaque. The drugs’ popularity would suggest physicians universally embrace them.

In recent years, however, some in the medical community have questioned whether statins are as effective in preventing cardiac events in women as in men, citing gender-specific analyses. And they point to evidence that suggests women are more likely to suffer side effects from them. For these reasons, skeptics ask why women should take them.

Gender Focus and Recent Trials

Supporters of statin use in women acknowledge that early trials and analyses lacked a gender-specific focus, but maintain that does not disprove statins’ benefit in women. They also point to a major statin trial that ended in 2008—involving more than 6,800 women— that showed a 46 percent reduction in cardiovascular events in women, compared to a 42 percent reduction in men.

Look at Overall Risk Profile

From my own 20-plus years of experience in treating cardiovascular disease, I believe statins are useful in helping prevent cardiac events in women, just as in men. As for side effects – typically muscle aches and discomfort – I have observed no significantly greater incidence in women.

In my opinion, the most important consideration when prescribing statins is not the patient’s gender, but her (or his) overall risk profile. Is the patient a diabetic? Hypertensive? Overweight? A smoker? What is her family history? A physician needs to determine a patient’s overall risk of cardiac disease and where a cholesterol disorder fits into that risk. In other words, it does no good to simply lower someone’s cholesterol but leave their blood pressure high. All cardiac health risks must be managed in a coordinated fashion.

If cholesterol-lowering strategies are in order, statins are not the only option. Diet, exercise, and even natural solutions can be effective. Physicians and patients should discuss these options so everyone is comfortable with the decision.

A well-informed medical opinion is critical to ensure you receive comprehensive care. Academic medical centers such as UT Southwestern offer well-trained, well-equipped cardiac specialists to handle virtually all aspects of cardiac disease, from initial diagnosis to treatment.