Women, Heart Disease & Statins: Resources we Like

By Cindy Pearson

Lately, the NWHN’s free health information service, the Women’s Health Voice, has been getting more questions from women who want to know what we think about cholesterol-lowering medications, collectively known as statins. Statins are sold under a variety of brand names, such as Crestor, Lipitor, and Zocor. Statins are recommended to women and men with heart disease to keep the disease from progressing and reduce the likelihood of heart attack and stroke. But, increasingly, healthy adults are being told to take statins to reduce the risk of developing heart disease. Cholesterol levels are used to determine who’s at increased risk of heart disease, along with other health factors, such as smoking, diabetes, and fitness.

In 2004, the federal government’s National Cholesterol Education Program (NCEP) lowered the level at which cholesterol is considered “high” and recommended that even patients with no risk factors other than high cholesterol use statins if they aren’t able to lower their cholesterol levels through diet and exercise alone. Since then, pharmaceutical companies have made an enormous investment in marketing statins to prevent heart disease.

That’s where the Network comes in. Women want to know if statins’ widespread promotion for prevention is yet another example of marketing trumping science. Is there good evidence that statins prevent heart disease in women? Or is this promotion of statins (like that of menopause HT for prevention) more hype than substance?

NWHN believes that the evidence that statins prevent heart disease in healthy women is not good enough. There are many areas of uncertainty: do high levels of cholesterol really predict risk in women as well as they do in men? Some studies say no. Do statins that have been shown to reduce risk in men work as well in women? We’re not really sure because most of the large trials didn’t include enough women. Do statins prevent disease in elderly women and men? Again, we’re not sure because many researchers restricted their long-term trials to volunteers who were under 70 when the trial began. And we’re skeptical of the NCEP’s cholesterol-lowering guidelines, which were developed by a committee dominated by researchers supported by manufacturers of cholesterol-lowering medications.

We encourage everyone with questions about this issue to start with an article we published a little over two years ago: “Exploring statins: What does the evidence say?” (WHA, May/June 2007). For those seeking more information, here are a few resources we like. Maryann Napoli, associate director of the Center for Medical Consumers, has written a very useful series of short articles about statins, heart disease, and women. They’re available at the Center’s website www.medicalconsumers.org. Check out “Take a Closer Look at Statin’s Benefit” (2008), “Statins: Low Odds of Benefit” (2006). and “Do Cholesterol-Lowering Drugs Benefit Women?” (2004). Harriet Rosenberg and Danielle Allard from the Women and Health Protection group authored an extensive report entitled “Evidence for caution: Women and statin use”, which reviews all the major studies, looks at assessments of benefits and safety, and explores the controversies surrounding cholesterol guidelines. The full report can be downloaded at www.whp-apsf.ca. The Canadian Women’s Health Network published a short article by Rosenberg and Allard summarizing their report, which is available in the Network’s on-line magazine, at www.cwhn.ca. The Public Citizen Health Research Group also has useful information on statins and cholesterol-lowering drugs, available though its Worst Pills, Best Pills on-line subscription service: www.worstpills.org. The “Women and heart disease: Selling statins” section of Our Bodies Ourselves: Menopause is a well-written explanation of how marketing trumps science in this area of women’s health. Finally, if you want to dig deep, the medical literature contains many scholarly articles with critical analyses of this issue. For example, “Statins, Cholesterol, Women and Primary Prevention: Evidence-Based Medicine or Wishful Thinking?” in Future Cardiology 2009; 5(1):1-4 and “Are lipid-lowering guidelines evidence based?” in The Lancet, January 2007.