Billed as the most comprehensive of its kind, a large meta-analysis (all of the large statin trials are represented in this analysis) suggests that statin benefits in reducing “major vascular events” are about the same in women as in men when adjusted for predicted cardiovascular risk .
Bearing in mind that approximately 20 million will die worldwide this year from cardiovascular disease, with 55% of the epidemic expressed in women. It’s therefore unfortunate that the idea has grown up in some places that women don’t benefit as much as men from statin therapy, and I think this idea has arisen because people haven’t taken into account the fact that women in general develop vascular disease later in life than men.
It is critical to identify women who are at risk for cardiovascular disease and offer them statin therapy if they exceed a certain threshold of risk, because vascular disease is common, especially in older women, and prevention of that disease could be facilitated by wider use of statin therapy.
The study was published online on January 9, 2015 in the Lancet.
The Cholesterol Treatment Trialists’ (CTT) Collaboration performed meta-analyses on data from 22 trials of statin therapy vs controls and five trials of more intensive vs less intensive statin therapy. A total of 46 675, or 27% of 174 149 randomly assigned participants in these trials, were women. Individual participant data were available from all 27 trials.
In each group of trials, mean concentrations of total and LDL cholesterol at baseline were similar in women as they were in men.
All trials (n=27)
|Group||Total cholesterol, mmol/L||LDL cholesterol, mmol/L||HDL cholesterol, mmol/L||Triglycerides, mmol/L|
Major Vascular Events
Among all 27 trials, statins reduced the risk of major vascular events by 21% for each 1.0-mmol/L reduction in LDL cholesterol (rate ratio 0.79, 95% CI 0.77–0.81; P<0.0001), with significant reductions in both women and women.
Major vascular events included MI, stroke, the need for coronary revascularization, and cardiac death.
The proportional reductions in major vascular events for each 1.0-mmol/L reduction in LDL cholesterol seemed slightly smaller in women than in men among the 22 trials of statin vs controls, but they were still highly significant (P<0.0001) in both women, at a rate ratio (RR) of 0.85 (99% CI 0.78–0.92), and men (RR 0.78, 95% CI 0.75–0.82).
Among the five trials where more intensive therapy was compared with less intensive therapy, the proportional reductions in major vascular events among women were similar to those in men. The proportional reductions in major vascular events were also similar among individuals with a definite history of vascular disease.
Somewhat in contrast, statin effects in subjects with no known history of vascular disease seemed slightly greater in men (RR 0.72, 99% CI 0.66–0.80) than in women (RR 0.85, 95% CI 0.72–1.00).
Among all 27 trials, statin therapy reduced the risk of major coronary events by 24% for each 1.0-mmol/L reduction in LDL cholesterol, with significant reductions in both women (RR 0.83, 99% CI 0.74–0.93; P<0.0001) and men (RR 0.74, 99% CI 0.70–0.78; P<0.0001). Statin therapy also reduced coronary-revascularization procedures by the same 24% percent for each 1.0-mmol/L drop in LDL cholesterol, again with no significant sex differences evident overall.
The overall proportional reduction of 15% in any stroke for each 1.0-mmol/L reduction in LDL cholesterol (RR 0.85, 95% CI 0.80–0.89) was also similar between women and men and again broadly similar at all levels of CVD risk. Importantly, reductions in major vascular events were also broadly similar irrespective of sex at all levels of CVD risk, including among women and men whose 5-year risk of having a major vascular event was low, at <10%.
Overall, statin therapy also produced a highly significant 12% proportional reduction in vascular mortality (RR 0.88, 95% CI 0.84–0.91) for each 1.0-mmol/L reduction in LDL cholesterol and a nominally significant reduction in deaths from unknown causes.
Finally, after adjustment for non-sex differences, there were similar proportional reductions in all-cause mortality for each 1.0-mmol/L reduction in LDL cholesterol of 10% in men (RR 0.90, 99% CI 0.86–0.95) and 9% in women (RR 0.91; 99% CI 0.84–0.99).
Importantly statin treatment had no significant effect on cancer or cancer mortality, and there was no evidence of any difference in the safety of statin therapy between women and men.
This report is critical to preventative cardiology as we have powerful statins at full dose (Rosuvastatin & Atorvastatin) capable of reducing LDL by 3-4 mmol/L. With statin associated independent reduction of us-CRP (inflammatory marker) we potentially can reduce individual morbidity and mortality by 80%.
Coupling statin therapy with aggressive lifestyle intervention with appropriate diet, exercise, sleep and stress reduction we can achieve excellent results, particularly in women.
- Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of LDL-lowering therapy among men and women: Meta-analysis of individual data from 174,000 participants in 27 randomised trial. Lancet 2015; DOI:10.1016/S0140-6736(14)61368-4