Statin Medications to Prevent Cardiovascular Disease in Women

For some women, taking a statin can help prevent heart attacks and strokes from happening or recurring.

The leading cause of death in U.S. women is cardiovascular disease (CVD; problems with the heart and blood vessels leading to blocked arteries, heart attacks, and strokes). Since 1983, more women than men have died of CVD each year. So it makes sense to look at ways of preventing CVD in women — and prescription medications called statins can help for some.

What Are Statin Drugs?

Statins are a group of prescription medications that lower cholesterol. They may also reduce inflammation in blood vessels, making it less likely for the vessels to get blocked like they do in heart attacks and strokes. You may recognize the names of some of these drugs, which end in “statin” (for instance, simvastatin, lovastatin, pravastatin, atorvastatin, rosuvastatin).

Statins are best known for their role in lowering cholesterol levels. Several types of fats in the blood can contribute to artery blockage, resulting heart attacks and strokes. Your total cholesterol level (TC) reflects how much cholesterol is circulating in your bloodstream. But that's not the whole story. There's “bad” cholesterol, or low density lipoproteins (LDLs), which clog arteries. For LDL levels, lower numbers are healthier than higher ones. And there's “good” cholesterol, or high density lipoproteins (HDLs), which seem to protect your heart and arteries. For HDL levels, the higher, the better. And finally there are triglycerides (TGs), another type of fat that affects cardiovascular health. This one can cause problems if it's very high.

Statins, CVD Prevention, and Women

We know that in both women and men who have already had a cardiovascular event (any incident, such as a heart attack or stroke, that causes damage by blocking blood vessels), a daily statin drug lowers the likelihood of a more events and of death from CVD. This is called secondary prevention — preventing more cardiovascular problems after you've already had one. We also know that, for men, statins are safe and effective in primary prevention — lowering the likelihood of a first cardiovascular event and death from CVD. But for women, it hasn't been clear whether statins are safe and effective for primary prevention. Is this because statins are really less effective or safe for women, or just because we haven't done enough research in women?

Most research projects on the safety and effectiveness of statins have been done mostly in men, with few women participating. Recently, however, researchers analyzed the results of 22 statin studies (more than 174,000 participants, of whom about 47,000 were women). The conclusion: Statins work and are safe in women and men for both primary and secondary prevention of heart attacks and strokes. Another primary-prevention research project tested whether statins prevent CVD in men and women with healthy LDL levels but inflammation in the blood vessels. In this study, statins also lowered the likelihood of CVD in women. Of course, statins don't prevent all CVD. Some women who took the medication did have cardiovascular events. But overall, fewer women taking statins had first or second heart attacks and strokes compared with women who weren't taking the drugs, making statins worth considering for many women.

Are Statins Safe in Women?

When considering any medication, you and your clinician (physician, nurse practitioner, or physician assistant) should weigh the likelihood of its benefits (protections the medication can provide) against its harms (possibly serious unwanted effects). Deciding about statins is no exception. Research shows that for most women at risk for CVD, the benefits usually outweigh the risks. The most common side effect in women is muscle pain; as many as 2 in 10 women experience this and may stop taking their statins because of it. Rarely, these medications can cause liver damage. If you are on a statin and develop severe muscle pain or symptoms of liver damage (yellow skin or eyes, pain on the right upper side of your stomach, or dark urine), you should immediately contact your clinician. Finally, statins slightly increase your risk for developing high blood sugar or diabetes. However, the protection these drugs provide for your heart and blood vessels outweighs this risk as well.

Women who are pregnant or considering becoming pregnant should not use statins, as they can cause harm to a fetus. Women who are breast-feeding should also avoid statins.

Should You Take a Statin?

In 2013, the American College of Cardiology/American Heart Association provided some guidelines for clinicians about prescribing statins for their patients, based on the best available research. Here are the four groups of people (both men and women) for whom statins are beneficial:

Those already diagnosed with CVD (for instance, a heart attack, stroke, or blocked arteries found on testing)
Those with an LDL cholesterol of 190 or higher
Those who are 40 to 75 years old and have diabetes and an LDL cholesterol of 70 to 189
Those who are 40 to 75, have an LDL cholesterol of 70 to 189, and have a high risk for CVD within the next 10 years

If you have had a cholesterol test, you should know (or find out) your numbers; if you haven't had this test, you should. But no one specific test can tell how likely you are to develop CVD. To learn your personal risk for developing it over the next 10 years, you can use the calculator provided by the American College of Cardiology/American Heart Association (see “Resources” below) or ask your clinician to calculate your risk and review it with you. Risk calculators take into account age, sex, race, smoking, blood pressure (and any treatment for it), diabetes, and cholesterol levels. Of course, they cannot predict for sure if you will have a heart attack or stroke in the next 10 years, but they can give you an idea of how high (or low) your risk is. You can use the information to make informed decisions about lifestyle changes and whether to take a statin — or to pat yourself on the back and continue your healthy habits.

In Conclusion

Lifestyle factors — especially quitting (or not starting) smoking, exercising, trying to achieve and maintain a healthy body weight, eating a healthful diet, and controlling health conditions like high blood pressure and diabetes — are always the first line of defense against CVD, the leading killer of women. For some women, taking a statin can further lower the likelihood of having a heart attack, stroke, or artery blockage. More studies on women and statins will be helpful (perhaps you'd like to enroll in one), but based on the research we have now, statins seem safe and effective for women as well as men.

Resources