Response to “A New Gender Issue: Statins” an Article by Roni Caryn Rabin

There appears to be an endless supply of medically related stories in the lay press that serve nothing more than to create mass misunderstanding of science and medicine. Surely their provocative messages sell papers and airtime. But they have an often-ignored downside as well. Tuesday we saw another such article. In the New York Times’ Rabin piece, a prevalent fear of medications is fueled, and the integrity of a prominent physician is impugned. (Full disclosure – I too unabashedly receive compensation from pharmaceutical companies for consulting and educational purposes.) Statistics are cited; the quintessential anti-statin doctor is quoted; and fabricated conclusions are rendered. The science of statin therapy is much too complex for a single cursory article to do it justice. In fact, entire conferences are devoted to the subject matter. And yet a sweeping conclusion – with potentially devastating ramifications – has again been made. Women reading this article will do what one would expect, either discontinue their statins on their own, or hopefully discuss such an action with their doctors prior to doing so. The article is meant to be terrifying, citing exceedingly rare muscle complications and referring to an unproved complication of statins, memory loss. So much is left unconsidered. For starters, the ACC/AHA risk scoring system cited by Ms. Rabin likely underestimates, not overestimates, CVD risk in women. And, as the leading cause of death in US women is cardiovascular disease, we do not want to make the mistake of under-evaluating and under-treating this segment of the population.

Today in the office I saw a young woman who suffers from premature heart disease that would not have been detected or appropriately treated had the guidelines been followed to a tee. Yet her coronaries have been non-invasively imaged; significant disease was detected; and yes, statins are being utilized. As a result, her life may very well have been saved. Doctors must be able to think and act with fluidity, moving both within and beyond the guidelines, in order to render the best care we can. Articles such as Ms. Rabin’s serve solely to diminish our ability to do so.

To demonstrate more clearly why we need to drastically broaden – not shrink – our efforts to identify and treat cardiovascular disease in women here are a few chilling and sobering statistics:

  • Women are 15 times more likely than men to die within the year following a heart attack.
  • Women with angina have twice the morbidity and mortality as men with angina, even in the absence of obstructive coronary artery disease.
  • 64% of women dying suddenly from heart disease had no prior symptoms.
  • Women under 50 are three times as likely as men under 50 to die after a bypass operation.
  • Marriage decreases cardiovascular risk in men, yet increases it in women (a frightening statistic, yet one that provides fodder for some excellent jokes).

Other similar statistics abound. The point is that we unambiguously understand that women are at great risk for heart disease. Sadly though, we currently have inadequate clinical trials assessing their risk. The appropriate answer is to fight even harder to identify and treat women at risk. It is not to dismiss our vast and growing understanding of the salient role cholesterol plays in the genesis of cardiovascular disease. It is not, as this article implies, to withhold a medication that has done more to thwart heart disease than any other therapy in the last century. I entreat all in the press to be more circumspect and responsible in your reporting. You have a great influence on your readers. Please wield it with caution.

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One Comment

  1. Sheri Loiacono July 25, 2014 at 9:08 am #

    I love this article. I actually see this Doctor. I too have a family history of high triglycerides specifically. Not easy or fun to deal with. To have open and honest communication with your doctor is imparative. Be careful what you read, everyones perceptions are all so different and complex. Your own uniqueness requires direct communication with your Doc for any medicinal changes…I do not like drugs of any sort but admire what they can do to assit in lowering cholesterol. Good advice.

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