Medications
Statins inhibit the liver enzyme hMG-CoA reductase, which is used in the manufacturing of cholesterol. They may also benefit the heart by mechanisms beyond lowering cholesterol levels, but what these are exactly is as yet unknown. They are the most effective drugs for the treatment of high cholesterol and are now strongly recommended as the first choice for lipid-lowering treatment for older women with heart disease. They may have other benefits for women as well.
Specific Statin Drugs. The statins include the two groups:
- So-called natural statins, including lovastatin (Mevacor), pravastatin (Pravachol), and simvastatin (Zocor). The natural statins are generally administered once a day; they should be taken in the evening because most cholesterol synthesis occurs between midnight and 3 AM. If more intensive treatment is required, a second, morning dose may be administered.
- Newer statins are fluvastatin (Lescol) atorvastatin (Lipitor), and rosuvastatin (Crestor). Some are taken twice a day. The newer agents may reduce LDL more effectively at equal doses to the natural statins, but more research is needed to confirm this.
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All are effective and safe. All are approved for lowering LDL. Although at this time only lovastatin and pravastatin are approved for prevention of heart disease and stroke, studies are showing the same benefits in the others. The differences among them are currently under investigation.
Benefits of Statins. Their potential benefits for older women are the following:
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Heart Disease. Evidence now reports that statins effectively reduce the risk of major coronary events, including first and second heart attacks, in women as well as men with evidence of heart disease. Of particular interest was a 2002 study indicating that statins may help reduce the risk for heart events posed by HRT. Experts estimate a 25% to 30% reduction in mortality rates when patients take statins after a heart attack. (Some believe the decrease may even be greater.) A pair of 2005 studies found that aggressive statin therapy reduced the risk of coronary disease by lowering not only cholesterol, but also C-reactive protein, a component in arterial inflammation.
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| A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle. |
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Stroke. Statins may also reduce the risk for stroke in patients with active heart disease and moderately high lipid levels. A 2005 study found that statins reduced the risk of brain damage and death after a stroke. (Only the natural statins have been studied, and their effect on stroke in patients with other risk factors is not yet known.)
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Click the icon to see an image of stroke. |
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Osteoporosis. There have been some reports and animal studies suggesting that statins may protect against bone loss in older women. It is not clear, however, if the statins themselves have properties that prevent osteoporosis or if any other cholesterol-lowering agents might be helpful. Few clinical trials have been published, to date, and more work is needed to confirm any effect on bones.
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Mental Decline. Of considerable interest are a number of studies now reporting a significantly lower risk for Alzheimer's disease in people who were taking specific statins. Those showing promise include lovastatin (Mevacor), pravastatin (Pravachol), and atorvastatin (Lipitor.) Other statins have not been associated with a lower risk for Alzheimer's. In fact, some researchers are concerned that certain statins that cross the blood-brain barrier may actually worsen Alzheimer's in people who already have it.
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