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

Should women be offered statin treatment? Certainly not!

11 May 2007

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: None declared

Uffe Ravnskov, independent researcher

Magle Stora Kyrkogata 9, 22350 Lund, Sweden

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