Women, Heart Disease and Statins

Posted by: Cathy Arnst on November 10

You may have already read about the statin study in the news today that found that the cholesterol-lowering drug Crestor reduced the risk of heart attacks, strokes and angioplasty in apparently healthy people by 45%. There is something else significant about the study—it is the first major statin trial to include women in the same numbers as men.

The investigators enrolled 6,801 women over age 60 (to make sure they were post-menopause), and 9001 men over age 50 in the international study, named Jupiter. As a result, the study may settle a controversy in the women’s health world—should women take statins? Based on Jupiter, the answer appears to be yes. Both male and female participants had a normal cholesterol reading but a higher than average level of a protein that can cause arterial inflammation, called C-reactive protein (CRP). The tested statin, Crestor, produced almost identical results in women as men in the trial, and it lowered both cholesterol and CRP in both sexes at similar levels (you can see the full results in this New England Journal of Medicine article).

Though it’s true that coronary heart disease fells more men, it is still the leading cause of death for American women. Nearly twice as many women in the U.S. die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer. Nevertheless, a commentary in The Lancet last year concluded that the use of statin drugs for women who do not yet have cardiovascular disease cannot be supported by existing data from clinical trials. They based their opinion on a review of data from eight randomized clinical trials.

But many medical experts disagreed, arguing that their is no physiological reason why a statin wouldn’t work as well in women as in men. And in the Jupiter trial, it did.

Of course, that’s not to say healthy women, or men for that matter, should run out and get a prescription for Crestor. The overall risk of a heart attack or stroke was extremely low in the tested group to begin with—157 in the placebo group over 1.9 years, compared with 83 in the Crestor subjects. That means you would have to treat 120 people with Crestor for 1.9 years to prevent one adverse event. That might seem worth it to you, but remember that every pill has side effects and risks, including statins.

Nevertheless, this study should be a wake-up call for women who think heart disease is not their problem. I know plenty of women who are religious about their annual mammogram but haven’t had their cholesterol or blood pressure checked in years. For more information on cardiovascular risk factors in women, check out the American Heart Association’s website page on women and heart disease. And for some detailed analysis of the Jupiter trial and what it might mean for men and women, read two blog posts by doctors, Dr. Matthew Mintz’s Jupiter is Out And The News Is Good!, and DB’s Medical Rants, one of my favorite doctor blogs.

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