WebMD Health News
Brunilda Nazario, MD
June 25, 2012 -- Women with heart disease may not benefit as much as men with heart disease from taking cholesterol-lowering drugs, a new research analysis suggests.
The review of studies evaluating statins showed that there was a reduction in death in men but not in women. The study concludes that there is no benefit of statins on stroke and all causes of mortality in women.
However, like men, women who had previous cardiovascular disease such as a heart attack, angina, or stoke and took a statin had a lower risk for a second heart attack, so the drugs do have clear benefits for women with heart disease, researchers say.
The findings raise new questions about whether true differences exist between men and women in their response to cholesterol-lowering drugs.
Just one-fifth of the participants in the trials were women, and it could be that this was too small to show real benefits.
"I don't really think biological differences between the sexes make women less susceptible to the benefits of using statins," researcher Jose Gutierrez, MD, MPH, of Columbia University, tells WebMD. "But if we want a clear answer to this question it is critical that more women be included in clinical trials."
The analysis included 11 major studies involving more than 43,000 people.
The studies were designed to examine whether statin therapy lowers heart disease and stroke risk in people who have had a previous heart attack, stroke, or other heart-related event.
Overall, statin use was associated with a similar reduction in recurrent heart attacks in men and women.
Among men, taking statins was associated with a decrease in strokes and death, but the difference was not seen in women.
The study appears in the June 25 issue of the journal Archives of Internal Medicine.
In an accompanying editorial, Fiona Taylor, PhD, and Shah Ebrahim, DM, of the London School of Hygiene and Tropical Medicine, point out that earlier reviews have shown at-risk women to benefit as much as men from the drugs.
They contend that the researchers failed to include relevant studies that would have shown a clear survival benefit associated with statin use in women with heart disease.
"We suggest that statins work just as well in women as in men," they conclude.
But cardiologist Rita F. Redberg, MD, says it is far from clear that this is the case, because so few women have been included in past clinical trials.
Redberg is director of Women's Cardiovascular Services at the University of California, San Francisco Medical Center, and she was an editor of the new study.
"Although there is a growing interest in personalized medicine, we still lack high-quality data on the largest group of patients in practice -- women," she wrote.
Redberg tells WebMD that since women tend to have a low risk for heart disease until they reach their mid-70s, it makes sense that they might not benefit as much as men do from statins.
She says that for most younger women, the risks of taking statins probably outweigh the benefits.
Muscle aches and problems with memory have been reported in statin users.
"If a woman is going to take a drug that might worsen her quality of life she needs to know there is a benefit," she says. "For most women, the evidence just is not there for statins."
She says at-risk women derive more benefit from making lifestyle changes to improve their heart health, such as not smoking, eating a healthy diet, and getting regular exercise.
Gutierrez agrees that addressing lifestyle is critical for women with heart disease, as is controlling diabetes, high blood pressure, and other health conditions that can lead to heart attack and stroke.
"Statins are not going to make a lot of difference if these issues aren't addressed," he says. "But I would feel terrible if even one woman didn't take statins because of this research. That is not the message."
SOURCES:Gutierrez, J., Archives of Internal Medicine, June 25, 2012.Jose Gutierrez, MD, MPH, Department of Neurology, Neurological Institute, Columbia University, New York, N.Y.Rita F. Redberg, MD, professor of medicine and director, Women's Cardiovascular Services, UCSF Medical Center.News release, Archives of Internal Medicine.
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