Statins: Some women don't get the benefits

For men and women with coronary heart disease or those at risk of it, losing weight and increasing their physical activity are key to effective treatment.

Risk factors include high blood pressure, diabetes, family history, high LDL (bad) cholesterol, and smoking.

Treatment might include taking a drug to lower cholesterol that belongs to a class of medications called statins. They can lower the LDL cholesterol level by inhibiting a key cholesterol-producing liver enzyme. Statins have been used in the U.S. since 1987, when lovastatin (Mevacor and now generic) was introduced.

Those medications, which lower LDL cholesterol levels and possibly have an anti-inflammatory effect, decrease blockages in the arteries that supply the heart, brain, and leg muscles in people who have atherosclerosis. Statins can reduce the chance of premature death for those with heart disease or people who have risk factors. Today 22 percent of Americans 45 or older are taking a statin.

How the sexes can differ

But in women who have only elevated LDL cholesterol and no known cardiovascular disease, statins don't seem to cut the risk of heart attack or fatal coronary heart disease as well as they do in men. Differences between the sexes have been borne out by several large, well-designed studies, which raises the question of how to treat women whose LDL cholesterol level is their only risk factor. Losing as much weight as possible, reducing saturated fat in the diet, and adding high-fiber foods are all important ways to reduce cholesterol levels. But at what point should medicines such as atorvastatin, lovastatin, pravastatin, or simvastatin be used?

With all their benefits, statins have downsides. Up to 10 percent of users experience bothersome muscle aches and pains. And a very small number of people (about one in 10,000 or fewer) can develop a serious and potentially deadly muscle problem. An estimated one in 100 people who take statins might develop abnormal liver-function tests. As with many drugs, we know a lot more about the short-term side effects of statins, like diarrhea and nausea, than the longer-term effects. That's why statin users should be checked regularly by their doctor. In most cases, those drugs require a lifetime commitment. Statins, especially branded ones, can be costly, which is why we encourage using generic versions noted in our free Best Buy Drugs reports.

Bottom line

Statins can be helpful, but women whose elevated LDL cholesterol level is their only risk factor for heart attack or stroke should consult with their doctor before committing themselves to lifelong use of a statin.