For more than a decade, Renu Kohli, 53, of Denver teetered on the edge of high cholesterol. Kohli worried about her risk for a heart attack, since she had a family history of heart disease.
"I felt uncomfortable because I live by myself and I always wondered what I would do if anything happened to me," she said.
Her daughter, a cardiologist, suggested taking a statin, a class of drugs used to lower cholesterol, to manage her symptoms. But her primary care physician disagreed, recommending diet and exercise instead.
"My primary care doctor thought [my cholesterol] wasn't high enough to go on statins," said Kohli, who also hesitated to take medication. And the conflicting recommendations just left her confused.
Whether to prescribe statins for women without heart disease, or whether they can even benefit, is a common quandary among many physicians. It's partly because many studies have yet to enroll enough women. But a new review of studies now suggests that women may reap as much benefit from statins as men do.
The study, whose results were published Monday in the Journal of the American College of Cardiology, reviewed 18 randomized controlled trials that included more than 140,000 patients, and found that statins decreased the risk of heart disease, stroke and death in both men and women equally.
"It seems that, with respect to statin therapy, what is good for the gander is good for the goose," the authors wrote.
While the researchers did not find a significant difference between men and women in the way statins work, they still cautioned that not enough data had yet been collected from women to mark a clear distinction. Twice as many studies were initially excluded from review because the researchers said they lacked information on the sex of the patients studied.
"This study just screams for the need for sex-specific reporting," said Dr. Sharonne Hayes, director of Mayo Clinic's Women's Heart Clinic in Rochester, Minn., who was not involved in the study.
While some experts said they prescribed statins to both men and women equally, others said not enough attention was paid to preventing heart disease in women, because they were often perceived to be at lower risk for the disease.
Women are more likely to develop the disease over their lifetime, often at a later age than men.
Still, women are less likely than men to receive statins, even if they exhibit symptoms of heart disease, according to a study published in the January 2009 issue of the journal Heart.
"The message now is when a woman is discussing statins with their physician, that gender should not be a characteristic in question," said Dr. William Kostis, clinical and research fellow in the divisionof cardiology at Massachusetts General Hospital in Boston, and lead author of the current study.
But according to Hayes, the result of the current study may not do much to change the minds of those who are reluctant to prescribe statins to women.
"They are demanding more rigorous trials and this meta analysis, while unique, does not provide that," said Hayes. Kohli, a vegetarian, said she feared the side effects of taking statins.
"I was very skeptical about going on it because a lot of people would tell me that you get muscle aches, and your liver function will be bad."
It's not clear how the side effects of the drug compare between men and women, according to the findings. Most of the studies analyzed did not record the sex of the patients who experienced side effects.
When Kohli's brother suffered a massive heart attack, she consulted additional doctors for their opinions and has been taking statins since November 2011.
"I feel a lot better," said Kohli, adding that she hasn't experienced any side effects. "I think it's one of the best things that's happened to me."
But it's hard to know if other women who don't have clear symptoms, or those considered at low-risk for heart disease, will benefit from statins.
The study does little to address that part of the debate, Dr, Lori Mosca, director of preventive cardiology at Columbia University Medical Center wrote in an accompanying editorial published in the Journal of the American College of Cardiology.
Until more studies track the side effects, the risk of death, to get a better sense of when and how statins should be used for women, "medicine is still an art," Mosca wrote.