Statins work for both men, women

Dear Dr. Roach: For 10 years, my daughter has refused statins (due to cholesterol level) on grounds that women were not a part of the studies recommending statins and that heart disease manifests differently in women. Her daily eating and exercise are stellar.

I have no family history of heart disease, but my cholesterol level warranted seeing a cardiologist. He says at my age (84) family history doesn’t apply, and my cholesterol warrants taking a statin. Every day when I swallow 20 mg of atorvastatin, I wonder if it’s going to cause a problem rather than solve one. Can you address the gender objection to statins?

C.D.C.

Answer: Women have different hearts from men and often have different symptoms of heart disease, so it makes sense to consider whether the same drug effective in men isn’t effective in women.

Historically, women have been underrepresented in studies on heart disease. Of 27 trials looking at effectiveness of statins in treating and preventing heart disease, only 27% of the subjects have been women. However, that still means that almost 50,000 women were studied, and statins were found to reduce relative risk just as effectively in women as they do in men.

I don’t have enough information to say whether you or your daughter are appropriate for statin therapy. The decision starts with estimating risk (by using a tool such as at tools.acc.org/ascvd -risk-estimator-plus/#!/ calculate/estimate/), explaining the benefits and potential harms of statins, and helping your patient make an informed decision.

Decisions should be based on sound science, not pharmaceutical advertising and not unwarranted fears.

The data are clear that these medicines, when used wisely, are helpful.

In women who have blockages in their hearts, statins should be prescribed (unless there is a good reason not to). For women without heart disease, the decision must be individualized.