Are statin side effects dependent on sex? A narrative review

Statins are the first-line treatment for dyslipidemia, which is a major modifiable risk factor for cardiovascular disease. One of the main problems in the dyslipidemia treatment is the frequently reported discontinuation of statins, mainly due to side effects of statins. The aim of the study was to summarize current knowledge on, and comprehensively discuss, the lower adherence to statins among women than men, and to assess whether gender is associated with the incidence of statin side effects. A narrative review was performed using data from articles found in a search of PubMed and Scopus databases using the terms related to statin adherence and statin adverse events by gender. Women are less adherent to statin therapy than men. Statin adverse events and statin intolerance appear to be the main cause of poor adherence to statin treatment. Women have been found to be more likely than men to stop or switch their statin therapy because of side effects, were less likely than men to perceive statins as safe or effective, and were more likely to report discontinuing statins because of adverse effects. Female sex has also been identified as a risk factor for statin intolerance. The reports reviewed in the manuscript indicate a higher prevalence of SAMS and new-onset diabetes among women than men. The risk also increases with age and is dose-dependent. Women have also been found to be more susceptible to the nocebo and drucebo effects of statins. Greater awareness of gender-specific side effects may lead to better tailoring of therapy and consequently to better adherence to statins among women, and thus the achievement of therapeutic goals in finally reducing cardiovascular risk.