Statins: What's Good for the Goose . . .

Any veterinarians in the readership, please forgive me as I mangle the gender of a well known phrase: what's good for the goose is good for the gander.  Apparently, goose are female and gander are male.  I did not know that.  In the world of medicine, many studies have been performed on white middle-aged males and assumed to apply to younger & older non-white females w/o confirmation.  Unfortunately, that assumption hasn't always been found to be true.  For instance, we now know that aspirin is good for prevention of heart disease in men while it's only useful for prevention of strokes in women (with other attendant factors & limitations thrown in).

Well, many of us have succumb to the literature poured upon us almost daily regarding the benefits of statins.  But in a meta-analysis of randomized, double-blinded, placebo-controlled trials published last month in the Archives of Internal Medicine, the authors concluded that while statins are equally effective in secondary prevention of cardiovascular events in both sexes, they do not decrease all-cause mortality in women.  And as we've noted in the past, all-cause mortality is the Holy Grail for which we search since we all have to die from something.  As I've attempted to conceptualize in the past, if we lower mortality from disease A but do nothing to improve mortality from disease B, we're just playing a losing game of Whac-A-Mole (with apologies to PETA).

To arrive at their conclusion, the authors analyzed 11 trials involving 43,193 patients (25% women) followed for as little as 16wks to as long as 6+yrs.  Compared to placebo, those men & women randomized to statins received a lower rate of any cardiovascular event, including myocardial infarction, cardiac intervention, stroke, and coronary death, as well as all-cause mortality.  When broken down by sex, men received all the above benefits in a statistically significant manner.  However, women who received statins did not demonstrate any improvement compared to placebo with regards to either all-cause mortality or type of stroke.

Of note, the authors acknowledged that by ignoring one study or another, the outcome of the statistical analysis would be different.  Regardless, the published results of this study contradict those of a meta-analysis published this past February in the Journal of the American College of Cardiology in which the authors studied 18 randomized trials involving 141,235 patients of whom 40,275 were female, and concluded that statins decreased risk of cardiovascular events and all-cause mortality in both women and men.

So what are we to do?  Throw the baby out with the bath water?  Let's remember that both meta-analyses concluded that statins lower risk of cardiovascular events in both women & men.  What's wrong w/taking advantage of that outcome?  Sure, I'd like to see agreement in lowering all-cause mortality but for now, I'll settle for lower risk of cardiovascular outcomes in both women & men.

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