Statin Side Effects in Women

Should women older than 75 take statins? Age not only increases the danger of heart disease but also sensitivity to side effects. Here's what you should know.

Cholesterol, the waxy substance produced by your liver, is critical to the normal function of all cells in your body. When there’s too much in your blood, cholesterol can form artery-clogging plaque — raising your risk of heart attack and stroke. As a result, people around the globe take a family of cholesterol-cutting drugs called statins.

Some people are hesitant to take statins. Older people and their doctors may have concerns, as age makes us more sensitive to side effects. There is also concern about people vulnerable to sleep disturbances, particularly women.

But, on balance, the world has signed on. The American Heart Association statement on statins is titled “Big Benefit with Low Risk.”

The guidelines in the U.S. recommend statins for people with high levels of low-density lipoprotein (LDL) cholesterol. You might also be offered a statin if you have a history of heart disease, stroke, peripheral artery disease, or other risk factors.  

Statins can include:

• Atorvastatin (Liptitor)
• Fluvastatin (Lescol XL)
• Lovastatin (Altoprev)
• Pitastatin (Livalo)
• Pravastatin (Pravachol)
• Rosuvastatin (Crestor, Ezallor)
• Simvastatin (Zocor, FloLipid)

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Heart disease and women

We tend to associate heart disease with men, but heart disease and stroke cause one in three deaths among women each year — more than all cancers combined. Because the symptoms in women are less obvious and can suggest a flu or simple back strain, women are often slower to seek help.

Do statins help if you’re older?

Most of the research on statins has come from pools of adults younger than 75, which is typical of drug trials. New results, however, are coming in. About 10 percent of patients stop taking a statin because the drug makes them uncomfortable.

One study examined the consequences when people ages 75 to 79 stop taking their statin regime. Their risk of landing in the hospital with a cardiovascular event was 25 to 30 percent greater than for people who stayed on the drug.

Another study found that taking statins regularly cut your risk of death by 34 percent. This was true for older women as well.

Statin side effects

Most side effects are mild and frequently go away as your body adjusts to the drugs.

Rare muscle problems, liver abnormalities, and memory loss have been reported. The Food and Drug Administration (FDA) has also warned that people taking statins may have a slight  increased risk of type 2 diabetes. The risk usually occurs when your blood sugar is already high, which is typical of prediabetes.

It’s clear that statins can affect mood, but rarely. The FDA-approved warning label notes a risk of nightmares, insomnia, and depression.

Some scientists link low total cholesterol with aggression and impulsivity. Because of this concern, doctors are less likely to prescribe statins to people with mood disorders. Research using data on 1,000 patients with schizophrenia or bipolar disorder, however, concluded that there was no relationship.

On the other hand, an analysis of a database of reports of adverse drug reactions from 2004 to July 2021 did turn up reason for concern, with thousands of reports registered related to a statin, nearly 80 percent of which were classified as serious.

Insomnia and depression were the most frequent complaints. There were six cases of suicide attributed to statins. Women were slightly more vulnerable than men, but age did not seem to be a factor.   

Statin side effects in women

In one study, scientists gave more than 1,000 adult men and postmenopausal women either a statin drug (simvastatin or pravastatin) or a placebo for six months. The study was double-blind, meaning that neither the study volunteers nor the researchers knew who was receiving a real statin and who was taking an inactive pill.

The team measured testosterone levels and documented sleep problems and aggressive behaviors before and after treatment with statins or placebos. The researchers concluded there was an increase in aggressive behavior in postmenopausal women taking the cholesterol-lowering drugs, especially for those over age 45.

What’s more, the increase in aggression (compared to placebo) was most dramatic in the female research subjects who began the study with the lowest aggressive behavior.

Men had the opposite response

When it came to the men, there was a significant decline in aggressive behavior — with a few exceptions. Three men who took statins demonstrated pronounced increases in aggression.

“Changes in testosterone and in sleep problems on simvastatin each significantly predicted changes in aggression,” explained lead author Beatrice Golomb, MD, PhD, a professor of medicine at the University of California, San Diego. “A larger drop in testosterone on simvastatin was linked, on average, to a greater drop in aggression. A greater rise in sleep problems on simvastatin was significantly linked to a greater rise in aggression.”

The disturbed sleep is likely the explanation for the rise in aggression involving the few male research subjects who became extremely irritable. “The two men with the biggest aggression increases were both on simvastatin, and both had developed ‘much worse’ sleep problems on the statin,” Golomb said.

Why do statins affect behavior?

Scientists haven’t pinpointed exactly how statins can impact behavior. Changes in testosterone and sleep patterns for those on simvastatin appeared to be the key factors associated with irritability. Golomb noted oxidative stress and cell energy affected by statins could also play a role.

For now, she said, the takeaway message is that statins can in rare cases have unpleasant effects. “Either men or women can experience increased aggression on statins, but in men the typical effect is reduction,” Golomb concluded.

If you believe you are experiencing any side effects from statins, including aggressive behavior, don’t stop taking your medication without talking to your healthcare provider. You may need to try another type of statin. Changing the dosage might help, too.

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