WHAT'S THE BEST STATIN FOR WOMEN? A DOCTOR SAYS ASK THESE 2 QUESTIONS FIRST

Statins are the go-to medications for lowering "bad" LDL cholesterol, reducing the risk of cardiovascular disease and improving long-term heart health. But is there such a thing as the best statin for women? We asked a top cardiologist for the nuanced answer-and key factors to consider when deciding which statin is right for you.

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These cholesterol-lowering medications are the biggest game changers in medicine, slashing the risk of heart disease and stroke. So why are they still controversial?

"Probably the biggest question I get is from people who say, ‘I don't want to take statins because I'm worried about cognition and memory,'" reveals Judith Goldfinger, MD, FACC, clinical cardiologist at Mount Sinai West and the director of Vascular Medicine.

"I tell them that statins are actually among the best drugs we have for lowering your risk of dementia. Often, people have to Google it because they don't believe it-what they've heard from friends or others in their circle is that statins carry a cognitive risk."

The opposite is true: By lowering lipid levels, statins protect the brain. "Statins reduce plaque in the carotid arteries, which are the major blood vessels to the brain, so that likely decreases cognitive issues," explains Dr. Goldfinger. "But most of the benefit is probably from direct effects in the brain, like reducing plaque in the smaller arteries there."

There's also something called microvascular disease, which affects tiny arteries, especially in older people, she says. "Lowering cholesterol helps with that, too. So, the short answer is that statins help prevent plaque buildup on multiple levels."

Adding to the largely unearned bad rap of statins is the fear of potential side effects, the most common being muscle aches. And while they do happen, major ones are rare. "The early statins had more side effects than the newer versions of the drugs," notes Dr. Goldfinger, "which is true for a lot of medications-they tend to get better over time."

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What's the best statin for women?

The short answer is that there isn't a single best statin for women. The exception is if you're pregnant or planning to become pregnant-in that case, no statin is considered safe.

"We don't use statins or other lipid-lowering medications in pregnant women," confirms Dr. Goldfinger. "That's because babies need fat for their brains to develop. So unless someone is at extremely high risk-such as if they've had a heart attack or stroke, where the ‘cholesterol math' is clearly in favor of lowering the mother's LDL-we generally don't want pregnant women taking statins."

There are a range of situations women of childbearing age may want to talk to their doctors about, she says. "I see a lot of women who say, ‘I'm not trying to get pregnant, but I'm not not trying,' or ‘I'm seriously thinking about getting pregnant in the next year.'" In those cases, Dr. Goldfinger wouldn't treat women with statins.

That said, it's important to note that there are exceptions. "The latest guidelines also highlight very high cholesterol due to familial or genetic risk factors," Dr. Goldfinger points out. "Rather than simply advising against medication, the guidelines recommend that women have a conversation with their doctor to assess the risks and benefits for the mother."

2 types of statins women should consider

Now that the most important consideration for women-the potential of becoming pregnant-is out of the way, the larger question becomes which statin is best for you, regardless of sex.

A helpful way to think about statins is that they fall into two categories: water-soluble, called hydrophilic (like rosuvastatin, brand-name Crestor) and fat-soluble, called lipophilic (like atorvastatin, brand-name Lipitor), explains Dr. Goldfinger.

"I find that if someone starts on a statin from one category and experiences side effects, most people will tolerate a switch to the other category," she adds.

How to choose the best statin for you

Here, Dr. Goldfinger points out a few factors that might help you and your healthcare provider decide which statin is the best one for you.

Do you have high triglycerides?

"Rosuvastatin [Crestor] also lowers triglycerides, a different component of the lipid panel," explains Dr. Goldfinger. When we talk about lipid-lowering, we're usually referring to LDL, the so-called ‘bad cholesterol,' which is mostly saturated fat.

Triglycerides, on the other hand, are more influenced by carbs and trans fats. "So if I see someone with both high LDL and high triglycerides, I'll often reach for rosuvastatin."

Do you have a family history of tolerating a certain statin?

"If a patient tells me, ‘My mother, father and sister all take Lipitor and it works great,' I don't think twice-I'll use that too," reveals Dr. Goldfinger.

"Even if someone says, ‘My family takes a less commonly used statin, like fluvastatin, I'll consider it, because there's always something to that. If a family does well on a particular medication, you don't necessarily need to change it," she adds.

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When it comes to the best statin, women have choices

Thankfully, we live in an era where there are many statin options, assures Dr. Goldfinger, "If we try one and you experience side effects, we can switch to another from a different category."

Another important factor to consider is that there are published tables showing the percentage of LDL reduction you can expect from each statin and at each dose. "These medications have been studied in very large populations, so we know, for example, whether to expect a 30 or 50 percent reduction," she explains.

"For many people, this may be the first medication they've ever taken. Even if we anticipate that someone may ultimately need a higher dose, it often makes sense to start low, check their blood work, see how they respond and then increase as needed rather than starting right away at the highest dose."

More heart-smart strategies:

How to Prevent Heart Disease Naturally: 5 Surprising Doctor-Backed Tips That Really Work

How To Improve Your Heart Health After 50-and Reduce Your Stroke Risk Too

Over 50? The Sneaky Signs of Heart Disease That Doctors Really Want You to Know

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

2026-01-15T03:36:10Z