BMJ  2007;334:982 (12 May), doi:10.1136/bmj.39202.399942.AD

Feature

Head to head

Should women be offered cholesterol lowering drugs to prevent cardiovascular disease? Yes

Center for Human Nutrition, Departments of Clinical Nutrition and Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, Texas 75390-9052, USA

Women in western countries are more likely to die from heart disease than from cancer. Scott M Grundy argues that the risks make preventive treatment essential, but Malcolm Kendrick believes the evidence of benefit is not strong enough

The first 150 words of the full text of this article appear below.

Primary and secondary trials show that cholesterol lowering drugs reduce the risk of cardiovascular disease events in men.^{1 2} Secondary prevention trials in women with established cardiovascular disease also show a reduction in risk.^{3 4 5} Meta-analyses also show that when all women with or without cardiovascular disease are combined, cholesterol lowering treatment produces benefit.^{6 7}

Some investigators nevertheless argue that women without cardiovascular disease should not be given cholesterol lowering drugs because of insufficient evidence from primary prevention trials in women.⁸ They speculate that women with and without cardiovascular disease respond differently to the drugs; if true, women may not respond to treatment even when they have the same level of risk as men who do benefit.^{1 2} This speculation discounts prospective studies showing that raised cholesterol concentration is a major risk factor for first heart attack in both men and women.⁹

The pathological basis for a difference in response to cholesterol lowering therapy . . . [Full text of this article]

Level of risk

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