Updated 23 September 2016

Statins similarly effective in men and women

Statins are just as effective at preventing cardiac events in women who have already had a heart attack or stroke as they are in men, according to a new meta-analysis.

Statins are just as effective at preventing cardiac events in women who have already had a heart attack or stroke as they are in men, according to a new meta-analysis.

However, the pooled data from 11 smaller trials didn't show a clear benefit when it came to strokes or all-cause mortality in women.

Although statins are widely used for secondary, some analysts have questioned whether they work as well in women as in men, said Dr. Jose Gutierrez from Columbia University in New York.

In their meta-analysis, he and his colleagues included randomised trials comparing statins to placebo in 43,000 people. The trials lasted anywhere from four months to more than six years; the drugs tested included simvastatin (Zocor), pravastatin (Pravachol) and atorvastatin (Lipitor).

Less risk of stroke when using statins

Overall, both men and women assigned to statins were 18% to 19% less likely to have one of several cardiovascular problems, including heart attacks, strokes and deaths related to heart disease.

For example, about 7% of both men and women on statins had a heart attack, vs 10% of participants receiving placebo.

Men taking statins also had a 19% lower risk of strokes in particular and a 21% reduction in all cause-mortality with statin treatment.

The same trend held up in women - but the effect was smaller, and the difference between the statin and placebo groups was not statistically significant, the researchers reported in the Archives of Internal Medicine.

Health disparities in women

Dr Gutierrez and his colleagues noted that both men and women had similar changes in their cholesterol while on the drugs, including a 26-point drop in total cholesterol in the statin group versus a three- to six-point difference among those taking placebos.

One limitation, the researchers noted, is that women only accounted for about 20% of the total cohort - so it's possible there just weren't enough of them to show the same effect of statins on strokes and deaths that was seen in men.

There are other possible explanations if women turn out to really not get as much benefit from statins, Dr Gutierrez said, such as the effect of hormonal differences.

"Another explanation could be the health disparity in women, and if they are sicker, probably we don't see as much benefit," he told Reuters Health.

Statin use in women supported

Dr Gutierrez noted that women in the studies his team evaluated were less likely to be taking aspirin and other potentially risk-reducing medications than men.

Despite some lingering questions, the researchers said their new analysis "supports the use of statins in women" who have already had a stroke or heart problems.

Dr Dennis Ko, a cardiologist at the Schulich Heart Centre at Sunnybrook Health Sciences Centre in Toronto, who wasn't involved in the new analysis, agreed.

"The overall benefit - it's pretty consistent for men and women," he said.

Drugs not end all on heart health

The analysis "still favours women to get statin medication (for secondary prevention) and not forgo it because they didn't see a mortality difference," Dr Ko said. "I think everything goes in favour of statin therapy."

But the drugs aren't the end-all, be-all for heart health, researchers said.

"Despite statins, cardiovascular events continue occurring," Gutierrez said. "They still happen regardless of what we do. So maybe besides statins, we should also concentrate on other factors that affect cardiovascular disease, such as hypertension, diabetes and smoking cessation."

(Genevra Pittman, Reuters Health, June 2012) 

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