For the last 20 years, statins have been used to lower cholesterol and prevent future heart attacks and strokes, but there have been conflicting results about the drugs’ benefits in women.
According to a new study that reviewed data from 11 trials representing 43,000 patients, statins are effective at preventing heart attacks and other cardiovascular events in women, but they are less effective at preventing stroke or death from any cause in women when the drugs are used in patients with a prior history of cardiovascular events or stroke.
The analysis, by researchers at Columbia University College of Physicians and Surgeons, found that statins reduced the rate of stroke and death in men and women, but the reduction in women was smaller and not statistically significant. The findings appear in the June 25 issue of Archives of Internal Medicine.
“The stroke result was a surprise to us, since other analyses have shown that statins reduce the chances of a woman having her first stroke,” says Jose Gutierrez, MD, MPH, the study’s lead author and a neurologist and clinical fellow in the Department of Neurology.
Gutierrez says that there are several potential explanations for the new results, including a dearth of women participants.
“Women represented only a fifth of patients in our study – and the small sample size may have limited the power of our study to detect a stroke benefit,” Gutierrez says.
Women in the clinical trials also had worse cardiovascular disease and were older than men in the studies. And compared to men in the trials, women were undertreated. Despite having worse disease, women had lower rates of medications used to lower blood pressure and lower rates of using aspirin to prevent heart attacks.
“Statins only target one thing: cholesterol,” Gutierrez says. “But these little differences in the use of other treatments could explain what we’ve seen.”
The take-home message, he says, is not for women to abandon statins.
“I’m a neurologist and I see women every day with stroke. I will never hesitate to give women statins,” he says. “Our study found that statins reduce the recurrence of cardiac events, but the outcomes aren’t clearly as beneficial in women for stroke. That should trigger a search for why: is it sample size, is it hormonal differences? We don’t know.
“The best thing to do is include more women in these studies. If we do that from the beginning, we won’t have these types of arguments.”