More on the Nocebo Effect of Statins…And With a Sex Bias

I discussed the N of 1 trial last month, on the nocebo effect of statins and how they can affect our ability to take statins.

On its heels, comes a paper by Jungyeon Moon, Robert Sedgh and Cynthia Jackevicius, that also looks at this nocebo effect a little differently, by retrospectively examining the  reported adverse events in the FDA Adverse Reporting System database from 2010 to 2019 [1]. 

They found a higher incidence of reported subjective “statin myopathy” events compared to objective adverse events (AEs), by a factor of 4.89 times,  more in women than in men (58:42). It is assumed that a large number of the “subjective” AEs are likely due to the nocebo effect.

How does this matka affect us?

If you are a woman and perceive subjective effects like weakness, lethargy, muscle pain that are likely to be “nocebo” effects rather than real adverse effects, you are less likely to take statins if and when needed or necessary. Your doctor may also not try to convince you to continue to take statins, since the cardiovascular risk in women, is perceived to be lower than in men, which in turn can lead to an unfortunate, potentially preventable, adverse cardiac event. 

This is our sex and gender (“who we are”) matka. Even in a relatively advanced society like Great Britain, women with heart attacks routinely get diagnosed much later, simply because the possibility of a heart attack does not enter the diagnostic differential when a woman above the age of 50 presents with chest pain [2].

If you are at risk for atherosclerotic cardiovascular disease (and remember, you can measure this risk yourself) and you need to take statins, which save lives, it makes sense to try everything possible to continue to take statins, unless there is definite objective evidence of a statin-related adverse effect.

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Footnotes:

1. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007480

2. https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/women-and-heart-disease/download-bias-and-biology-briefing