Both Sexes Benefit from Statins, Or Do They?

Statins reduced adverse cardiovascular events and all-cause mortality in both men and women, based on a meta-analysis reported in the February 7 issue of the Journal of the American College of Cardiology.

Statin therapy reduced major adverse cardiovascular events by 19% in women and by 23% in men and all-cause mortality was lowered by 10% and 16%, respectively, according to lead author, William Kostis, MD, PhD, of Massachusetts General Hospital in Boston, and colleagues.

"Statin therapy should be used in appropriate patients without regard to sex," the researchers concluded. "It seems that, with respect to statin therapy, what is good for the gander is good for the goose."

However, there is a healthy difference of opinion among the experts, as excerpted from MedPage Today:

 Lori Mosca, MD, PhD, lead author of the 2011 American Heart Association Guidelines for Cardiovascular Disease Prevention in Women, urged caution, in an accompanying editorial, noting that the analysis focused on relative risk reduction, had a limited number of primary prevention trials, and had a limited assessment of the costs and risks of statin therapy.

"Sex-specific results in cardiovascular prevention trials should be provided for relative and absolute benefits, adverse outcomes, and cost-effectiveness," says Dr. Mosca. "Only then we will know with less uncertainty whether what is good for the gander is also good for the goose. Medicine is still an art."

Although statins have well-established benefits in secondary prevention, published data suggest that statins might not be as effective for women, particularly when used for primary prevention. That's because women without cardiovascular disease have a lower annual risk of mortality and lower cardiovascular risk than men without cardiovascular disease.

"Therefore, the absolute benefit of statins will typically be less for women than men, suggesting it might be appropriate that women receive statins less frequently than men in the setting of primary prevention," says Lori Mosca, MD, professor of cardiology at Columbia University Medical Center, NY.

Despite all of the evidence pointing to differences in cardiovascular response in women, John Messmer, MD, of Penn State College of Medicine, believes that “gender does not mean we treat differently for cardiovascular and cerebrovascular disease," whereas Lee Green, MD, MPH, of the University of Michigan, suggests that "[t]here really isn't much reluctance to prescribe statins to women, but there should be [since] benefit has been asserted where there really isn't evidence for it.”

Barbara H. Roberts, MD, author of The Truth About Statins and Associate Clinical Professor of MedicineAlpert Medical School of Brown University, RI, points to Lori Mosca’s comment in the accompanying editorial, indicating that the absolute benefit of statins will be less for women “suggesting it might be appropriate that women receive statins less frequently than men in the setting of primary prevention.” And as she added “the authors did not have enough data to critically evaluate adverse side effects…”

“We have almost no data on the adverse effects of long term use of high dose statins, but we do know that women are more likely than men to have side effects,” adds Barbara Roberts, MD. “Most telling is that 17 of the 18 trials were sponsored by the pharmaceutical companies who made the statins involved.

“While Lori Mosca’s editorial was well-written and brought out several limitations and considerations of this particular study and statin treatment in different sexes, unfortunately publications are generally taken as fact by the majority,” observes Marjorie R. Jenkins, M.D. Executive Director of Laura W. Bush Institute for Women’s Health at Texas Tech University Health Sciences Center, and a leader in the Advancing Women’s Health Initiative, which aims to promote a greater understanding of sex and gender differences in optimizing that medical care for all.