Women & Statins - 18
- Dr. Thomas J. Lewis
- Dec 26, 2023
- 7 min read
Updated: Dec 28, 2023
Summary:
Statins cause diabetes - Blog 14
Women derive NO benefit from statins
Few statin studies included women
Women and Statin Drugs
From my book, "Health Freedom Lost."
Far too many healthy people are coerced into taking statins and women top the list. A significant amount of research indicates the drugs will do them little good and may be more likely to cause serious side effects in women.
“If you’re going to tell a healthy person to take a medicine every day for the rest of their life, you should have really good data that it’s going to make them better off,” said Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, and the former editor of JAMA Internal Medicine. Lowering cholesterol should not be an end in itself, she stated, “You can have high cholesterol and still be really healthy and have a low risk of heart disease,” she said.
Although women represent slightly more than half of the population, they have been vastly underrepresented in clinical trials of statins. As a result, evidence of the benefits and risks for women is limited. Women develop heart disease about 10 years later in life on average than men.
Studies have found that healthy women who took statins to prevent cardiovascular disease did experience fewer episodes of chest pain and had fewer treatments like stents and bypass surgery. But statins did NOT prevent healthy women from having their first heart attacks and did NOT save lives. The Jupiter trial, which included 6,801 women age 60 and older, found a lower risk of hospitalization for unstable angina, but that was the only real benefit.[i]
The absolute number of these adverse health issues was tiny, and there was no reduction in heart attacks, strokes, and deaths in women. “The data are underwhelming, to say the least,” said Dr. Barbara Roberts, author of “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs” and an associate professor of medicine at Brown University. “Women who are healthy derive no benefit from statins. I have women come to me who were put on statins in their 30s by their physician because their cholesterol was a point or two above what’s said to be normal,” Dr. Roberts said. “This is insane.”
But Dr. Roberts advises women that they can reduce their heart risk by watching their weight, exercising, and following a diet rich in fish, fruits and vegetables, nuts, and olive oil — and, if they’ve never had heart trouble, forgetting statins. “We know you can get the benefit and relative risk reduction from adhering to a Mediterranean-style diet,” she said.
Medscape produced an article titled, "Statins, Cholesterol, Women, and Primary Prevention: Evidence-Based Medicine or Wishful Thinking?"[ii] Their summary is provided here.
"A basic tenet of modern cardiology is that elevated cholesterol increases the risk of myocardial infarction (MI - a heart attack). Significantly lowering cholesterol should, therefore, reduce MI risk. Statins reduce cholesterol and, in some contexts, adverse heart outcomes, but meta-analyses of primary prevention clinical statin trials have found no statistically significant cardioprotective effect for women. These meta-analyses reasonably reflect the individual primary prevention trials."
"Of these studies, none showed statistically significant cardioprotection for women and some yielded hazard ratios exceeding one meaning they had worse outcomes compared to no treatment. The meta-analyses are consistent with the absence of effect for women in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), atorvastatin's (Lipitor®) primary prevention clinical trial, and are also consistent with the unpublished Carotid Atorvastatin Study in Hyperlipidemic Postmenopausal Women (CASHMERE) atorvastatin clinical trial, which demonstrated no improvement in carotid intima-media thickening (IMT) in a study limited to postmenopausal women."
"The cholesterol-heart attack link and the achievement of lowered cholesterol without protective effect is an important scientific puzzle."
There is really no puzzle. Lowering LDL, thus total cholesterol is not the proper target to prevent heart disease.
[i] Kostapanos, Michael S., and Moses S. Elisaf. "JUPITER and satellites: Clinical implications of the JUPITER study and its secondary analyses." World Journal of Cardiology 3.7 (2011): 207.
[ii] https://www.medscape.com/viewarticle/587563. April 18, 2022.
From the NY Times - 2014 - uncut.
Should so many women be taking statins?
Medical guidelines issued late last year may double the number of Americans who are told to take these cholesterol-lowering drugs. But the recommendations don’t distinguish patients by gender, and a small, increasingly vocal group of cardiologists believe that’s a mistake.
Far too many healthy women are taking statins, they say, though some research indicates the drugs will do them little good and may be more likely to cause serious side effects in women.
“If you’re going to tell a healthy person to take a medicine every day for the rest of their life, you should have really good data that it’s going to make them better off,” said Dr. Rita Redberg, a cardiologist at the University of California, San Francisco, and the editor of JAMA Internal Medicine.
Lowering cholesterol should not be an end in itself, she added, and
cholesterol may not play the same role in heart disease in women as in men.
“You can have high cholesterol and still be really healthy and have a low risk of heart disease,” she said.
Although women represent slightly more than half of the population, they have been vastly underrepresented in clinical trials of statins. As a result, evidence on the benefits and risks for women is limited.
Women tend to develop heart disease about 10 years later in life on average than men; women’s risk begins to equal that of men when they reach their mid-70s.
Studies have found that healthy women who took statins to prevent cardiovascular disease did experience fewer episodes of chest pain and had fewer treatments like stents and bypass surgery.
But statins didn’t prevent healthy women from having their first heart attacks and
didn’t save lives.
The Jupiter trial, which included 6,801 women age 60 and older, found a significantly lower risk of so-called soft endpoints, like hospitalization for unstable angina, among healthy women taking statins.
But the absolute number of these health setbacks was small, and there was no significant reduction in heart attacks, strokes and deaths among these women.
“The data are underwhelming, to say the least,” said Dr. Barbara Roberts, author of “The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs” and an associate professor of medicine at Brown University. “Women who are healthy derive no benefit from statins, and even those women who have established heart disease derive only half the benefit men do.”
Lewis comment: Half of an adverse benefit is still adverse.
Dr. C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute in Los Angeles, disagreed. “We haven’t shown that we can prevent deaths, because we just haven’t enrolled enough women, and that’s a crime,” she said. “But the absence of data is not the same as negative data.”
In the meantime, she said, “we can either sit on our hands or use our best judgment to make an educated guess, and can decide to treat.” (Dr. Bairey Merz has had financial relationships with drug companies, including Abbott Vascular, Bristol-Myers Squibb and Gilead.)
Lewis: Drugs, money, and the narrative - ugh.
The debate has taken on added urgency because of the risks associated with statins, which often are supposed to be taken daily for the rest of one’s life. The drugs have long been known to cause muscle pain in some people and, more rarely, liver and kidney damage, as well as cognitive side effects like memory loss and confusion.
In 2010, Johns Hopkins researchers discovered that statins could make the body produce antibodies against its own proteins, engendering a painful and debilitating muscle disease that actually gets worse when patients stop taking the drugs.
But the most common side effect is diabetes. (which, of course, is the leading cause of heart disease. Do not trust me but read on.
In 2012, researchers published a study showing that postmenopausal women who took part in the Women’s Health Initiative were much more likely to develop diabetes if they took statins, and diabetes itself increases the risk of heart disease considerably.
Despite the concerns, women are heavy users of statins, especially in midlife — when the gap in heart disease risk between men and women happens to be greatest. Some 16 percent of women ages 45 to 64 take statins, compared with 18 percent of men.
Over all, 26.9 percent of men 45 and over take statins, compared with 23.6 percent of women, though significantly more elderly men than elderly women use statins.
Even critics of statin use in healthy women say they would not hesitate to prescribe the drugs to patients with established heart disease. But since cholesterol readings are increasingly used as quality indicators to rate physicians and health plans, many younger adult women may feel pressured to take the medicine even though they are in good health, some doctors say.
“I have women come to me who were put on statins in their 30s by their physician because their cholesterol was a point or two above what’s said to be normal,” Dr. Roberts said. “This is insane.”
Although the new treatment guidelines recommend lifestyle changes for lowering cholesterol, Dr. Bairey Merz said: “I think they should probably go out the window. We have yet to find any kind of lifestyle change intervention that actually helps people live longer.”
Lewis - Ugh - Idiot?!
But Dr. Roberts advises women that they can reduce their heart risk by watching their weight, exercising and following a diet rich in fish, fruits and vegetables, nuts and olive oil — and, if they’ve never had heart trouble, forgetting statins.
“We know you can get the benefit and relative risk reduction from adhering to a Mediterranean-style diet,” she said.
Index & Upcoming (short) blogs on cholesterol and statins
Number 1: Cholesterol fun (true) facts - completed
Number 2: Is the actual cholesterol molecule important? c - completed
Number 3: What is an optimal TC value? Remember, no one knows their actual cholesterol molecule value. - completed
Number 4: Surprising fact about cholesterol as an antibiotic - completed
Number 5: TC simple math - dumb doctors - completed
Number 6: What is LDL really? - completed
Number 7: Statins - do they lower the cholesterol molecule? - completed
Number 8: What did we learn from the new "biologics" to lower "cholesterol" - completed
Number 9: Niacin and other "cholesterol" management treatments - completed
Number 10: What did Natasha Campbell-McBride say about cholesterol/lipids? - completed
Number 11: What is a QALY, and how does it relate to "cholesterol"? - completed
Number 12: Idiot doctor from Johns Hopkins, Roger Blumenthal - completed
Number 13: Statins cause Alzheimer's and ALS - THEHIGHWIRE - completed
Number 14: Statin drugs CAUSE diabetes - completed
Number 15: The statin merry-go-round to poor cardiovascular outcomes - completed
Number 16: How statins CAUSE heart disease - completed
Number 17: Women and statin drugs
Number 18: If not "cholesterol," then what?
Number 19: Who says statins do NOT extend life?
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