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

BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39202.399942.AD (Published 10 May 2007) Cite this as: BMJ 2007;334:982

Should women be offered statin treatment? Certainly not!

Professor
Grundy´s main argument for prescribing cholesterol lowering drugs to women is
that such treatment reduces their risk of cardiovascular events.1
Obviously he is dismissing the fact that no trial or meta-analysis has found any
effect on coronary or total mortality in women. Or perhaps he feels that the
relatively ‘tiny’ reduction in non-fatal cardiovascular events overwhelms
the adverse effects. It is true that, according to all industrial-sponsored
trial reports, side effects from statin treatment are rare, but much evidence
tells us that they are underreported.2 Muscular symptoms, for
instance, are said to occur in less than one percent, but researchers
independent on the drug companies have found the frequency to be 10-20 %,3
64 %4 and even 80 %.5 This side effect may not only be
painful, it also hampers exercising, the most important preventive measure for
cardiovascular disease.

     Information of
new side effects are also slow to appear. In a study of 82 male patients with
heart disease sponsored by Pfizer, 20 % became more or less impotent already
after six months of statin treatment.6 But although this observation
was published February 2006 nothing is mentioned on Pfizer´s homepage for
atorvastatin.

    
Adverse effects from the reproductive system are
to be expected in women as well. For instance, small doses of simvastatin added
to cultures of human first trimester placental explants inhibited migration of
extravillous trophoblast cells, increased apoptosis of cytotrophoblast cells and
decreased secretion of progesterone.7 These effects may be
responsible for the high frequency of spontaneous abortion and the birth of
children with severe malformations already seen after first-trimester statin
exposure.8

    
They key question is this. Do the benefits from
a tiny, but statistically significant reduction, in the risk of a non-fatal
stroke or heart attack, both of which may heal with little or no clinical
sequelae, outweigh the much greater risk of severe debilitating muscle problems,
becoming infertile, or giving birth to a child with malformations. Not to
mention the many more uncommon, but also more serious side effects. I would say,
very definitely, no.    

  1. Grundy
    SC. Should women be offered cholesterol lowering drugs to prevent
    cardiovascular disease. BMJ  2007;334:982
     
  2. Ravnskov
    U, Rosch PJ, Sutter MC, Houston MC. Should we lower cholesterol as much as
    possible? BMJ2006;332:1330-2.
  3. Marzoa-Rivas
    R, Crespo-Leiro MG, Paniagua-Marin MJ, Llinares-Garcia D, Muniz-Garcia J,
    Aldama-Lopez G et al.
    Safety
    of statins when response is carefully monitored: a study of 336 heart
    recipients.
    Transplant
    Proc
    2005;37,4071-3.
  4. Langsjoen
    PH, Langsjoen JO, Langsjoen AM, Lucas LA.
    Treatment
    of statin adverse effects with supplemental Coenzyme Q10 and statin drug
    discontinuation.
    Biofactors 2005;25:147-52.
  5. Sinzinger
    H, O'Grady J. Professional athletes suffering from familial
    hypercholesterolaemia rarely tolerate statin treatment because of muscular
    problems. Br J Clin Pharmacol 2004;57: 525-8.
  6. Solomon
    H, Samarasinghe YP, Feher MD, Man J, Rivas-Toro H, Lumb PJ, Wierzbicki AS,
    Jackson G.
    and
    others. Erectile dysfunction and statin treatment in high cardiovascular
    risk patients. Int J Clin Pract 60, 141-145, 2006.
  7. Kenis
    I, Tartakover-Matalon S, Cherepnin N, Drucker L, Fishman A, Pomeranz M,
    Lishner M.
    and
    others. Simvastatin has deleterious effects on human first trimester
    placental explants.
    Hum
    Reprod
    2005;20, 2866-72.
  8. Edison
    RJ, Muenke M. Central nervous system and limb anomalies in case reports of
    first-trimester statin exposure.
    N
    Engl J Med
    2004;350, 1579-82.

 

Competing interests:
None declared

Competing interests: No competing interests

11 May 2007
Uffe Ravnskov
independent researcher
Magle Stora Kyrkogata 9, 22350 Lund, Sweden
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