Statins and Primary Prevention of Cardiovascular Disease in Women

Objectives. A systematic review of randomized clinical trials and meta-analyses evaluating the efficacy, tolerability, and safety of statins in preventing cardiovascular disease (CVD) in women without cardiovascular disease. Background. Several meta-analyses have been performed evaluating statins in CVD primary prevention trials involving women. This review is an update incorporating the results of recent CVD primary prevention trials in women and the recent concerns of statins and new-onset diabetes. Method. PubMed database was searched for primary prevention trials and meta-analyses. The key terms “statins, cardiovascular disease, primary prevention in women” were used. Search was limited to all English publications published up to October 2012. Results. Statin use led to a trend towards reduction in cardiovascular mortality and morbidity in women. No significant increased risk in adverse events was observed. The slight increased incidence of diabetes is outweighed by the greater cardiovascular benefit derived from statin use. Conclusions. The data support the use of statins for primary prevention of CVD in women at higher risk of CVD. The lack of statistical significance in prior randomized controlled trials and meta-analyses is attributable to the lower numbers of women enrolled in these trials and the lower CVD risk of women in the trials resulting in the inadequate powering of these studies. Higher risk women who may benefit from CVD primary prevention with statins may be identified using validated tools such as the Reynolds scoring system, the 2011 American Heart Association risk algorithm for women, and the forthcoming National Heart, Lung, and Blood Institute risk equations.