New Research Shows Women Are Vastly Undertreated for Heart Disease Compared to Men

Women are less likely than men to receive cholesterol-lowering drugs that could protect their health, according to a new study.

Specifically, as compared to older men, older women with heart disease aren’t treated as often with statins or other cholesterol-lowering medications, despite the fact that the treatment is recommended for both genders.

The new research also found that women are less likely to be prescribed both statins and ezetimibe, another cholesterol-lowering drug if statins alone aren’t helping.

The findings were presented at a European Society of Cardiology (ESC) conference in April, but have not yet been published in a peer-reviewed journal.

“While this is not the first study to show sex disparities in statin therapy, the first important thing to note is that despite studies showing this again and again, the problem is not getting better,” said Alexander Turchin, MD, associate professor of diabetes, endocrinology, and hypertension at Brigham and Women’s Hospital.

“We need to urgently understand why this is happening and how we can serve our female patients better,” he told Health.

Here’s what experts had to say about the new research, why gender disparities persist in heart disease care, and how to best protect your health.

People with a specific type of heart disease called coronary artery disease often have elevated LDL cholesterol levels, putting them at high risk for heart attacks. Because of this, these patients can usually benefit from taking some kind of cholesterol-lowering drug.

For people who can tolerate them, statins are usually a go-to treatment and work by reducing the amount of LDL cholesterol in the blood. If statins alone don’t help someone get to optimal levels, patients are usually encouraged to add another cholesterol-lowering drug called ezetimibe to their treatment plan. Target levels for LDL cholesterol are the same for men and women.

Though these guidelines are clear, this new research suggests a gap in treatment for women with heart disease.

Researchers from Sweden looked at 1,037 men and 415 women who were diagnosed with coronary artery disease between 2012 and 2020. The male and female participants were, on average, 68 years old and 70 years old, respectively. None of them had experienced a heart attack.

The research team followed up with participants three years after their diagnosis and found that 54% of women were using cholesterol-lowering drugs, as compared to 74% of men. And just 5% of women were taking a statin and ezetimibe, while 8% of men were taking both medications.

Additionally, this research found “that the sex disparity increases with time, with more women than men discontinuing statin therapy,” Turchin explained.

Across all ages, medication usage was highest after people were diagnosed, but it went down over the following years—and the dip was most profound in women.

For instance, 65% of women under 60 were taking cholesterol-lowering drugs the week after their diagnosis. Three years later, only 52% were still taking their medication. For men under 60, medication usage was much more stable—79% were taking it immediately after diagnosis, and 78% still were years later.

Overall, men were more apt than women to reach their LDL cholesterol targets.

“Our findings should be a wake-up call about the undertreatment of women with heart disease,” Nina Johnston, MD, PhD, study author and researcher from Uppsala University in Sweden, said in a press release. “Equal prescribing practices are needed so that women receive all recommended therapies and are protected from adverse outcomes.”

This new research follows a long line of studies that have found treatment disparities between men and women with heart disease.

Over two decades ago, Michael Miller, MD, professor of cardiovascular medicine at the University of Pennsylvania and Penn Medicine, similarly found that women’s treatment for heart disease lagged behind significantly.

“The new study extends these findings by including non-statin therapies (such as ezetimibe), that were not available when our study was done,” Miller told Health.

More recently, a 2019 report noted 67% of women were on a statin compared to about 78% of men. That same study showed about 19% of the women said they hadn’t previously been offered a statin compared to roughly 14% of men. Women were also more likely to decline statins and were less likely to agree that they drugs were safe and effective.

Additionally, a 2023 study found that, among older adults with high cardiovascular risk, women were less likely to start statin therapy. Yet another trial showed that fewer women achieved their LDL cholesterol and blood pressure goals when researchers compared therapies.

Johnston told Health that her team is investigating why these disparities exist, and that further research is needed.

One possible explanation, Johnston said, is that women may be less likely to undergo a revascularization process, or receive a stent. These patients are always evaluated by cardiologists, and tend to have higher usage rates of cholesterol-lowering drugs, especially as compared to patients who are only treated by primary care doctors, she explained.

Concerns about side effects could be another driver of these disparities, experts agreed. For one, Johnston said, “more women than men report side effects of statins.”

Hearing stories about these side effects—which include muscle aches, fatigue, headache, and more—could make some women afraid to try the drugs, Turchin explained.

Some women may believe that supplements can work better, or that statins have devastating side effects, “neither of which are true except in very rare circumstances,” Miller added.

Another reason why women may hesitate: They typically develop heart disease at an older age than men do, and may be reluctant to add another medication to their routine, said Turchin.

“Older people are generally the most likely to get a heart attack or a stroke,” he added. “They need more protection from them, not less.”

Determining whether you need statins or other cholesterol-lowering medications depends on each individual.

U.S. guidelines recommend doctors prescribe statins to anyone ages 40 to 75 who has a higher risk of a cardiovascular disease and at least one risk factor for heart disease, such as diabetes or hypertension.

“Statins should be started once a diagnosis of coronary artery disease is made, or earlier in patients at high cardiovascular risk,” said Johnston.

If you’re concerned about how gender may be impacting your care, Miller suggested asking your healthcare provider to confirm that women should be getting the same treatment for heart disease as men. If the provider is unclear, seek out a different doctor, he said.

It’s also important that physicians take concerns about statin side effects seriously. If it means more women take the drugs, it may be helpful for doctors to slowly increase medication doses in female patients over time, Johnston explained.

“The importance of statin treatment in coronary artery disease needs to be explained to all patients, but especially women who appear to be more skeptical as to the benefits,” she said.