Men and women--similar but not identical: insights into LDL-lowering therapy in women from the Cholesterol Treatment Trialists Collaboration.

Abstract

Evaluation of: Fulcher et al. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. Lancet 385(9976), 1397-1405 (2015). A recent publication has explored the role of gender in determining the benefit from statins. Using data on 174,000 patients (including 46,000 women) collected up to 2010, a meta-analysis was performed using individual patient data, separately analyzing results for men and women and adjusting for baseline risk and nongender related risk factors. Over a median duration of follow-up of 4.9 years, statins reduced the risk of major vascular events by 21% for each mmol/l reduction of LDL cholesterol (relative risk: 0.79; 95% CI: 0.77-0.81; p < 0.001), reducing risk by 22% for men and 16% for women. There was no significant overall heterogeneity for the benefit achieved in men versus that achieved in women after adjusting for baseline risk. Baseline risk substantially affected the absolute number of events prevented, but did not affect the proportional benefit attributed to the use of statins. Total mortality was similarly and significantly reduced in men (10%) and women (9%). This study adds to existing literature in confirming that statins have demonstrable benefit in men and women.