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Midlife and Menopause

Questioning The Role Of Cholesterol in Heart Disease in Women

Many of us have been advised to monitor our cholesterol levels and take cholesterol-lowering drugs to prevent heart disease. But cholesterol may not be as important as we are often told.

Cholesterol-lowering statin drugs have been on the market since 1987 and are the bestselling class of drugs in the United States. But still there is not a single “gold standard” randomized controlled trial that shows that these drugs are beneficial to women who do not yet have heart disease. Furthermore, a study that followed the health of 7,300 Chicago women for thirty-one years found that elevated cholesterol levels played a small but statistically insignificant role in their risk of death due to heart disease and had no effect at all on their overall rate of death.21

Another study showed that statins not only fail to reduce the risk of heart attack and stroke in people between seventy and eighty-two years old who don’t already have heart disease, but they significantly increase the risk of cancer in this population (by 25 percent).22 Other studies have not found a higher cancer risk with statin use, but the people in those studies were much younger.

Another study found that for women who have reached the age of sixty-five, not only is high cholesterol not a health risk, but—going directly against our common wisdom—the higher older women’s bad (LDL) cholesterol levels, the longer they live.23 The catch is that the women in this study lived in small Italian towns, almost certainly eating healthier diets and getting more exercise than most Americans.

So why are millions of women without heart disease taking cholesterol-lowering drugs?

The answer is found in the recommendations of the supposedly “evidence-based” guidelines issued by the National Cholesterol Education Program. This program is coordinated by a division of the National Institutes of Health, but many of the authors of the guidelines have financial ties to companies that manufacture cholesterol-lowering drugs. Section II of these guidelines states definitively that clinical trials show statins reduce the risk of coronary heart disease in women without heart disease (so-called “primary prevention”).24 Readers are referred to a table that convincingly cites seven studies that supposedly support this claim. But in fact, not a single one of these studies actually provides such evidence. Only one of the seven included any women who didn’t already have heart disease, and in this study there were only a total of twenty heart events that developed in the women, not nearly enough to provide a statistically significant finding.25

Section VIII of the same 284-page document says that there are no clinical studies that support the claim that statins are beneficial for women who are at increased risk but have not yet developed heart disease: “Clinical trials of LDL lowering generally are lacking for this risk category....”26 In other words, the statement made in Section II, which appears to justify millions of women taking these drugs, is simply not true.

Women and health care providers are being misled by such guidelines, which often are developed by experts with financial ties to drug makers. (For more information, see “Can We Trust the Evidence in Evidence-Based Medicine?” and the book Overdosed America, by John Abramson.)

If you are considering taking a statin to lower cholesterol and you do not already have heart disease, you may want to weigh the potential risks against the lack of proven benefit. Learn what you can and discuss your individual situation with a knowledgeable health care provider. If lowering cholesterol plays a role in improving your health, it is far less important than each of these healthy ways of living:

  • Exercise routinely
  • Eat a Mediterranean-style diet
  • Don’t smoke
  • Reduce chronic stress
  • Avoid eating foods containing trans fats (partially hydrogenated fats)

Adopting and maintaining these healthy habits is the most effective, safest, and least expensive way to prevent heart disease and improve your chances of living a long and healthy life.

End of excerpt
Excerpted from Chapter 17: Heart Health in
Our Bodies, Ourselves: Menopause  © 2006 Boston Women's Health Book Collective


21. Martha L. Daviglus, Jeremiah Stamler, Amber Pirzada, Lijing L. Yan, Daniel B. Garside, Kiang Liu, Renwei Wang, Alan R. Dyer, Donald M. Lloyd-Jones, and Philip Greenland, "Favorable Cardiovascular Risk Profile in Young Women and Long-Term Risk of Cardiovascular and All-Cause Mortality, " JAMA 292(2004):1588-92. [back to text]

22. J. Sheperd, G. J. Blauw, M. B. Murphy, et al. on behalf of the PROSPER study group, "Pravastatin in Elderly Individuals at Risk of Vascular Disease (PROSPER): A Randomized Controlled Trial," Lancet 360, no. 1 (2002):1623-300. [back to text]

23. Valerie Tikhonoff, Eduardo Casiglia, Alberto Mazza, et al., "Low-Density Lipoprotein Cholesterol and Mortality in Older People," Journal of the American Geriatrics Society 53, no. 2 (2005):159-64. [back to text]

24. National Cholesterol Education Program, "Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)," accessed at http://www.nhlbi.nih.gov/guidelines/cholesterol/index.htm on March 17, 2006. [back to text]

25. J. R. Downs, M. Clearfield, S. Weis, et al., "Primary Prevention of Acute Coronary Events with Lovastatin in Men and Women with Average Cholesterol Levels: Results of AFCAPS/TexCAPS," JAMA 279, no. 1 (1998):615-22. [back to text]

26. National Cholesterol Education Program, "Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)," page VIII-3, accessed at http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.htm on March 17, 2006. [back to text]

Excerpted from Our Bodies, Ourselves: Menopause, © 2006, Boston Women's Health Book Collective.

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