Should women be offered cholesterol lowering drugs to prevent cardiovascular disease? No

doi:10.1136/bmj.39202.397488.AD

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Malcolm Kendrick, general practitioner

24 Prestwick Close, Tytherington, Macclesfield, Cheshire SK10 2TH

malcolmken{at}doctors.org.uk

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

As no other cholesterol lowering drug has been shown to improve survival, this discussion is effectively about the use of statins. To date, none of the large trials of secondary prevention with statins has shown a reduction in overall mortality in women.1 Perhaps more critically, the primary prevention trials have shown neither an overall mortality benefit, nor even a reduction in cardiovascular end points in women.2 This raises the important question whether women should be prescribed statins at all.

I believe that the answer is clearly no. Not only do statins fail to provide any overall health benefit in women, they represent a massive financial drain on health services. This money could be diverted to treatments of proved value.

In addition to the lack of benefit and expense, statins …