Side effects of statins in females
Pro Research Analysisby 
Searched over 200M research papers
Side Effects of Statins in Females
Statins and Insulin Sensitivity in Women with PCOS
Statins, particularly atorvastatin, have been shown to impair insulin sensitivity in women with polycystic ovary syndrome (PCOS). A study conducted at Oulu University Hospital in Finland found that while atorvastatin therapy improved chronic inflammation and lipid profiles, it significantly increased fasting insulin levels and decreased insulin sensitivity over a six-month period1. This is particularly concerning for women with PCOS, who are already at an increased risk of developing type 2 diabetes mellitus. Therefore, the initiation of statin therapy in these women should be carefully considered based on individual cardiovascular risk assessments rather than solely on the presence of PCOS1.
Genetic Factors and Statin-Induced Side Effects
The SLCO1B1*5 genetic variant has been associated with an increased risk of statin-induced side effects, including myopathy. A pharmacogenetics study found that women carrying this allele were more likely to experience adverse events such as myalgia and elevated creatine kinase levels, particularly when treated with simvastatin2. This suggests that genetic screening could be beneficial in identifying women at higher risk for these side effects, allowing for more personalized and safer statin therapy2.
Muscle-Related Side Effects in Elderly Women
Elderly women are particularly vulnerable to muscle-related side effects from statins. These side effects range from common but mild myalgia to rare and severe rhabdomyolysis. The risk is higher with more lipophilic statins like simvastatin and is dose-dependent3. Factors such as advanced age, female gender, and comorbid conditions like diabetes and hypothyroidism further increase this risk. Strategies to mitigate these side effects include using lower doses, intermittent dosing, or switching to less lipophilic statins3.
Gender Differences in Statin Side Effects and Adherence
Women are more likely than men to discontinue or switch statin therapy due to side effects, particularly muscle symptoms. A survey from the Understanding Statin Use in America and Gaps in Patient Education (USAGE) study found that 31% of women reported new or worsening muscle symptoms compared to 26% of men6. Additionally, women were more likely to be dissatisfied with their statin therapy and less adherent to their prescribed regimen. Improved communication between clinicians and female patients about the benefits and risks of statin therapy could enhance adherence and treatment outcomes6.
Cardiovascular Risk and Statin Therapy in Women
Despite the benefits of statins in reducing cardiovascular morbidity and mortality, women are often underdiagnosed and undertreated for cardiovascular diseases. They are less frequently prescribed statins and, when they are, they receive lower doses compared to men. Women also have a higher risk of non-adherence to statin therapy and are more likely to discontinue treatment due to side effects7. Factors such as a lower glomerular filtration rate, higher body fat percentage, and faster statin metabolism in women contribute to these differences. For women of childbearing age, the potential teratogenic effects of statins necessitate discussions about contraception before initiating therapy7.
Conclusion
Statin therapy in women presents unique challenges and risks, particularly concerning insulin sensitivity in women with PCOS, genetic predispositions to side effects, and higher susceptibility to muscle-related issues in elderly females. Gender differences in side effects and adherence further complicate treatment. Personalized approaches, including genetic screening and tailored dosing strategies, along with improved clinician-patient communication, are essential to optimize statin therapy in women.
Sources and full results
Most relevant research papers on this topic
Statin therapy worsens insulin sensitivity in women with polycystic ovary syndrome (PCOS): a prospective, randomized, double-blind, placebo-controlled study.
Atorvastatin therapy improves chronic inflammation and lipid profile but impairs insulin sensitivity in women with PCOS.
RCT
Rigorous Journal
Highly CitedThe SLCO1B1*5 genetic variant is associated with statin-induced side effects.
The SLCO1B1*5 genetic variant and female sex are associated with mild statin-induced side effects.
RCT
Large Human TrialHighly CitedRisk identification and possible countermeasures for muscle adverse effects during statin therapy.
Statins are effective in preventing cardiovascular disease, but they carry a risk of muscle complications, such as myopathy.
Highly CitedStatin therapy: does sex matter?
Additional research is needed to guide clinical recommendations specific to women, as current guidelines do not offer sex-specific recommendations for women.
Systematic Review
Very Rigorous JournalMuscular effects of statins in the elderly female: a review
Statin-related muscle disorders are more likely in elderly women, and reducing these side effects could improve patient compliance and overall outcomes.
Literature ReviewVery Rigorous JournalHighly CitedGender differences in side effects and attitudes regarding statin use in the Understanding Statin Use in America and Gaps in Patient Education (USAGE) study.
Women are more likely to stop or switch statins due to side effects, particularly new or worsening muscle symptoms, and improved communication between clinicians and patients can improve adherence and outcomes.
Observational StudyHighly CitedCardiovascular Risk and Statin Therapy Considerations in Women
Women face higher cardiovascular risk and statin therapy considerations compared to men, with women at higher risk of non-adherence and discontinuing treatment due to side effects.
Rigorous JournalHighly CitedAdverse effects of statin therapy: perception vs. the evidence – focus on glucose homeostasis, cognitive, renal and hepatic function, haemorrhagic stroke and cataract
Long-term statin therapy is remarkably safe with a low risk of clinically relevant adverse effects, outweighing the risk of adverse effects.
Systematic ReviewHighly CitedSex Differences in the Use of Statins in Community Practice.
Women are less likely to receive statin therapy or at the recommended intensity, due to less frequent offers, more frequent declines, and more frequent discontinuations.
Observational StudyHighly CitedAssociation of patient, provider and facility related characteristics with statin associated side effects and statin use: Insight from the veteran's affairs healthcare system.
Statin use is significantly disparitated by sex, ASCVD type, and comorbidities among secondary prevention patients with statin-associated side effects, highlighting the need for improved statin utilization.
Observational Study