Anti-cholesterol drugs can 'safely' benefit female cardio disease

Published in The Lancet​, the results of the international meta-analysis trial involved more than 174,000 people—the largest body ever investigated—and will reassure doctors that statins’ benefits outweighed their risks at a time when more are recommending them to patients.

The drugs are already so popular about 40 per cent of Australians aged over 65 are using them.

Until now, statin therapy has been hotly debated as a means of primary prevention in women as well as men. This is because women tend to develop heart disease later in life, and so have not previously been featured in a wide body of research. 

However, the new research shows that statins—a class of drugs used to lower cholesterol by inhibiting a liver enzyme that produces the molecules—will not only benefit women who have already had a heart attack or stroke, but also those who haven’t but are at an elevated risk.

Beyond reasonable doubt​

Professor Anthony Keech of Sydney University, research lead in an Anglo-Australian team, said the results “resolve a major uncertainty​” about the use of statin therapy on women.

"It has long been known that by reducing low-density lipoprotein [LDL] cholesterol, statin medications prevent heart attacks and strokes in people at risk of these diseases​,” he said.

“As a result, the benefits of statin therapy in women have been uncertain, especially in the absence of any previous history of cardiovascular disease​.

"This analysis of the effects of statins was undertaken by combining results from 27 different trials, and shows beyond any reasonable doubt that women gain the same benefits from statins as men​," he said.

The researchers found that statin treatment reduced the risk of a major vascular event, such as heart attack, stroke, the need for bypass surgery or cardiac death by more than one-fifth for each 1 mmol/L reduction in LDL cholesterol achieved. 

This reduction was similar in both women and men, regardless of their history of cardiovascular disease, leading to a reduced risk of death in both genders—a finding that had not until now been reported in any individual statin trial.

Reassuring statin-happy doctors​

"There has been a recent worldwide shift towards recommending treatment with statins to people without existing cardiovascular disease but with a sufficiently high risk of future disease. The results of this study will reassure doctors that these risk-based guidelines for treatment can be applied to men and women equally​," Professor Keech said.

Co-investigator Dr Jordan Fulcher, a Sydney University cardiologist, said the finding will likely prompt Australian doctors to follow the US and Britain, where statins are now recommended for people with a 7.5% and 10% per cent risk of a vascular event over 10 years respectively. ​

In Australia, more than 11,500 women die of these two diseases every year.

"Far too few women realise they are at greater risk of dying from a heart attack than from breast cancer and this study should reassure them that, if advised by their doctor, they can reduce that risk by taking a statin​."

Professor Len Kritharides of the Heart Foundation of Australia has agreed with Sydney scientists’ conclusions, saying the results show “unequivocally” that statins prevent heart attacks “without evidence of serious harm”.

"These results should give great encouragement to patients and their doctors that lowering cholesterol with statins prevents cardiovascular disease,” he said.