Efficacy and Safety of LDL-Lowering Therapy Among Men and Women: Meta-Analysis of 174,000 Participants

For years there was lingering doubt about whether statins work as well in women as in men — a doubt that, left unaddressed, led to undertreatment of women. This large meta-analysis was designed to settle it.

Pooling individual data from over 174,000 participants across 27 randomized trials, the Cholesterol Treatment Trialists found that statin therapy produced essentially the same proportional reduction in major vascular events for women as for men — about 16 and 22 percent per unit of LDL lowering respectively, with no statistically significant difference by sex. All-cause mortality fell in both. At equivalent baseline risk, the benefit is equivalent.

The practical message corrects a real disparity: there is no good reason to treat women’s cholesterol less aggressively than men’s. The same LDL-lowering logic, and the same expected benefit, applies.

We rate the evidence very strong. An individual-patient meta-analysis of this scale is among the most reliable forms of evidence, and it provides a definitive answer to a clinically important question about who benefits from statins.