February is American Heart Month, and the spotlight is on heart health. Throughout this month, we will be featuring articles including discussions with physicians in the Massachusetts General Heart Center to learn more about the topics surrounding heart disease, the leading cause of death in the U.S. for both men and women.
Statin Effects in Women:
featuring Q&A with William J. Kostis, PhD, MD, clinical and research fellow in cardiology at the Mass General Heart Center
In this second discussion about heart health, William J. Kostis, PhD, MD, a clinical and research fellow in cardiology at the Mass General Heart Center, talks about the effects of statins in women. Kostis was the lead author of a recent meta-analysis which compared statin effects in men versus women published in the Journal of the American College of Cardiology.
February is American Heart Month. Why is it important for Americans to be educated on heart topics?
It is important because heart disease is a major cause of death and disability in both women and men in the United States. In fact, heart disease is still the number one cause of death in both women and men in this country. Greater awareness of the importance of cardiovascular health and risk-reduction strategies can help people to lead longer, healthier lives. Such strategies include pursuing a good diet and exercise regimen and avoidance of behaviors that increase cardiovascular risk (e.g. smoking).
How are statins effective in treating cardiovascular disease, and when are they used?
Statins are one class of lipid-lowering medications that lower LDL (“bad”) cholesterol. They can also decrease triglycerides (another fatty substance in the blood) and raise HDL (“good”) cholesterol. Statins have been shown to decrease cardiovascular events (e.g. heart attacks and strokes) and also to reduce death from cardiovascular causes. These benefits are due to their improvement in patients’ lipid profiles and possibly also due to other effects (including anti-inflammatory effects and benefits to the function of blood vessels). Statins are used by patients with risk factors for cardiovascular disease (including high blood pressure, high cholesterol, diabetes, smoking, and a family history of early heart disease) and by those who have already suffered cardiovascular events. Although the benefit of statin use is more pronounced in reducing cardiovascular events among those patients who have already suffered one, our analysis has shown that they can help prevent first events. Most patients would prefer not to have an event in the first place and it is our goal as physicians to help them in this pursuit.
Prior to this meta-analysis, what have we known about the effects of statins in women?
Many large-scale studies of cardiovascular medications have historically had a low representation of women. Statins are no exception. The majority of studies demonstrating the benefits of statin therapy included far more male than female participants. Although there were suggestions that statins were similarly effective in both genders, these studies yielded insufficient statistical proof of their benefit in women.
What are the key findings in this research, and is there work you would like to focus on in the future?
The use of statins prevents both cardiovascular events and death in both women and men. These benefits were seen both in patients with a history of prior cardiovascular events (e.g. heart attacks and strokes) and also among those at risk who have not had such an event. These benefits were also shown to extend to people traditionally considered to be of lower risk. Statins are safe and well-tolerated in most cases, as observed in large trials and in widespread clinical use over the last two decades, and it will be important to continue to study their benefits and side-effects in all demographic groups as we move forward.
What should physicians take from the meta-analysis? How about patients who are on statins or ones who may be using them in the future?
Statins should be considered as part of the treatment plan for all suitable patients, regardless of their gender. These agents should be used as one part of a comprehensive cardiovascular risk reduction program, including diet and exercise.
For more information about heart health, visit the MGH Heart Center’s page.