Benefit of statins confirmed for CVD prevention in women
NEW evidence has emerged to show that statins are as effective for primary prevention of cardiovascular events in women as in men.
A re-analysis of the US JUPITER trial, including 6801 women aged 60 years and older with raised CRP and low LDL-C, has found 20 mg per day of rosuvastatin (Crestor) led to similar relative risk reductions in CVD rates in asymptomatic women (by 46%) and men (by 42 per cent).
When the results were synthesised with a meta-analysis of five trials for statin use in 20,147 women for primary prevention, statin therapy showed a one-third relative reduction in primary CVD in women, a benefit similar to that seen in previous meta-analyses of men.
A sub-group analysis also found statin therapy significantly reduced arterial revascularisation or unstable angina in women and suggested women with a family history of premature coronary disease would benefit more from rosuvastatin.
Statin use for primary prevention had been especially controversial for women, the authors said, with prior meta-analyses showing smaller and non-significant cardiovascular event reductions among women.
Professor Leon Simons, director of the lipid department at St Vincent’s Hospital in Sydney, said the results were reassuring and expanded on previous evidence by including more women and achieving a greater reduction in LDL-C.
However, he said how the findings could be applied remained controversial.
“It is not simply selection of those with raised [c-reactive protein],” Professor Simons said.
“The editorial writers suggested the use of statins (not just rosuvastatin), in post-menopausal women with at least one other traditional risk factor, especially a family history of premature CVD. This would include women with low LDL-C.”
In addition, the cost of preventive use would be prohibitive, he said.
“How clinicians might apply these findings requires a major paradigm shift, which is not currently catered for under PBS subsidy guidelines. Nor can I see the PBS guidelines changing overnight because this could lead to a further cost blowout.”
The JUPITER study was funded by AstraZeneca.