Menopause and Heart Health: Should You Be on a Statin?

Menopause marks the end of the menstrual cycle and it can also be an important turning point in a woman’s heart health. When estrogen levels drop, total cholesterol levels rise, increasing the risk of heart disease, the leading cause of death in women.

“Misconceptions that women have a lower risk of heart disease, as well as concerns about side effects, prevent many women from using statins,” says Haitham Khraishah, MD, a preventive cardiologist at University Hospitals Harrington Heart & Vascular Institute. “Statins can help protect the heart, but many women are choosing not to start statin therapy, even when it’s recommended.”

Menopause, Cholesterol and Statins

Menopause doesn’t cause heart disease, but the risk increases as menopause approaches. Estrogen protects against heart problems, helping women’s blood vessels stay open and clear.

When estrogen decreases, blood vessels may become less flexible and more prone to narrowing. This, combined with changes in cholesterol levels, can increase the risk of atherosclerosis, a disease where plaque buildup causes the arteries to harden and thicken. If blood vessels to the heart or brain become blocked, heart disease or stroke can occur.

Statins can help lower cholesterol by reducing the production of low-density lipoprotein (LDL), aka “bad” cholesterol, in the liver. Lower LDL levels are associated with less plaque buildup in the blood vessels and arteries.

Are Statins Safe and Effective for Women?

Most women tend to do well on statin therapy. Statins help control cholesterol and reduce the risk of developing heart disease. They can cut heart attack and stroke risk by 20 percent. Statins also lower heart-related deaths in women.

“While many clinical trials have historically enrolled fewer women than men, the available evidence suggests that statins are safe and effective at reducing heart disease in both,” says Dr. Khraishah.

Should You Take a Statin?

Statins are used to prevent heart disease and to treat it in women who already have it. “Statins are especially good at lowering LDL cholesterol,” says Dr. Khraishah. “They are used to reduce the chance of another heart attack, stroke or worsening heart-related symptoms.”

Statins may be recommended if you:

• Are post-menopausal. Because heart disease risk spikes as estrogen decreases during menopause, statin therapy is especially beneficial for women in this life stage.
• Already have high cholesterol or heart disease. Statin therapy can help lower cholesterol and manage the effects of heart disease-related problems.
• Have diabetes. Since people with diabetes are twice as likely to have heart disease or stroke, the benefits of statins typically outweigh the rare risk of statins causing increased blood sugar levels.
• Are an older woman. While statins are beneficial as post-menopausal women age, women over age 75 years should discuss the risks and benefits with their doctor.

Statins are not recommended for:

• Women who could still get pregnant. If a woman becomes pregnant, statins can be harmful to a developing baby. They should not be taken while breastfeeding either. Effective contraception is necessary for any woman of childbearing age taking statins.

Side Effects of Statins

Some women worry about the side effects of statins, but the risk of serious side effects is quite low. “Many women taking statins report symptoms such as muscle aches, weakness or joint pain,” says Khraishah. “But significant damage to the muscles — and in the most extreme cases, kidney damage — is very rare.”

Muscle weakness and other muscle-related side effects are more common among women taking statins than men. Dr. Khraishah suggests this may be due to:

• Lower muscle mass: Women generally have less muscle mass than men, so any weakness or pain may be more noticeable.
• Differences in metabolism: Some studies suggest that women may metabolize statins differently, which could lead to increased risk of side effects.
• Tendency to report symptoms: Women tend to be more attentive to bodily changes and they’re more likely to report side effects in clinical studies.
• Other causes: Muscle pain is common in the general population and can be influenced by other factors like aging, physical activity, or coexisting conditions such as fibromyalgia or vitamin D deficiency.

Statins may also increase blood sugar and diabetes risk, but this side effect is rare. The risk may be reduced by lowering the dose, switching to a different statin or taking statins every other day.

Can You Lower Cholesterol Without a Statin?

Women often wonder if they can make lifestyle changes instead of taking a statin to lower cholesterol and manage the risk of heart disease. Depending on your risk factors, lifestyle changes may help. But if you’re genetically predisposed to high cholesterol, they may not be enough.

Following a healthy lifestyle is still recommended, regardless of your cholesterol or heart risks or whether you’re taking a statin.

• Get regular exercise. Aim for at least 30 minutes most days. Try to get a mix of cardio and strengthening exercises.
• Eat a balanced diet. A plant-based diet, like the Mediterranean or DASH diet, that includes lots of veggies and whole grains, as well as lean meats and fish, is a good choice for heart health. It’s also important to avoid (or at least limit) highly processed foods, sweets and sugary drinks.
• Practice healthy habits. Avoid smoking, avoid or limit alcohol, do your best to manage stress and get enough sleep each night.

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The experts at University Hospitals Harrington Heart & Vascular Institute have the advanced training and experience to diagnose and treat all types of cardiovascular conditions.