Statins are among the most widely prescribed medicines in the UK, yet a persistent gap exists between men and women in who receives them. According to research published in the British Journal of General Practice, women at equivalent cardiovascular risk are significantly less likely to be offered statin therapy than men — a pattern that has narrowed but not closed in recent years.

For community pharmacists, understanding this disparity matters. Pharmacy teams are often the first point of contact for patients collecting new prescriptions or asking about cholesterol, and they are well placed to identify patients who may benefit from a conversation with their GP about cardiovascular risk.

The scale of the gap

A 2023 analysis of English primary care data found that women aged 40–74 with a QRISK3 score above 10% were approximately 20% less likely to have been initiated on a statin than men with the same risk threshold. The gap was most pronounced in the 40–54 age group, where cardiovascular risk in women is often perceived as lower — despite QRISK3 explicitly accounting for sex-specific risk factors including premature menopause, systemic lupus erythematosus and migraine with aura.

NICE Clinical Guideline 181 recommends offering atorvastatin 20mg to adults with a 10-year cardiovascular risk of 10% or more, regardless of sex. The guideline makes no distinction between men and women in its treatment threshold.

Why the gap persists

Several factors contribute to the under-prescribing pattern:

Risk perception. Coronary heart disease has historically been framed as a male condition. While awareness of women's cardiovascular risk has improved — particularly following campaigns by the British Heart Foundation — the perception gap has not fully closed among either clinicians or patients.

Side effect concerns. Women report statin-related muscle symptoms at higher rates than men in observational studies, though randomised controlled trial data (notably the Cholesterol Treatment Trialists' Collaboration meta-analyses) show similar rates of confirmed myopathy across sexes. The discrepancy between reported and confirmed side effects complicates clinical conversations.

The menopause transition. Lipid profiles change significantly around menopause, with total cholesterol and LDL-cholesterol typically rising. This creates a window where cardiovascular risk increases but may not yet be captured by a QRISK3 assessment performed several years earlier. Pharmacists seeing patients for NHS Health Checks or blood pressure monitoring may be the first to notice this shift.

Patient reluctance. Survey data from the British Heart Foundation suggests that women are more likely than men to express concern about long-term medication and to seek reassurance about statin safety before agreeing to treatment.

What the trial evidence shows

The Cholesterol Treatment Trialists' Collaboration published a landmark sex-specific meta-analysis in The Lancet in 2015, pooling data from 27 randomised trials involving more than 174,000 participants. The findings were clear: statins reduced major vascular events by approximately 21% per 1 mmol/L reduction in LDL-cholesterol in both men and women. The relative risk reduction was statistically indistinguishable between sexes.

For primary prevention specifically — the scenario most relevant to community pharmacy — the absolute benefit is smaller (because baseline risk is lower), but it remains proportional to baseline risk regardless of sex. A woman with a QRISK3 score of 15% derives broadly the same proportional benefit from statin therapy as a man with the same score.

The pharmacy role

Community pharmacists can contribute to closing the prescribing gap in several practical ways:

NHS Health Checks and blood pressure monitoring. Pharmacists delivering blood pressure checks are already identifying patients whose cardiovascular risk may warrant further assessment. When a woman aged 40–74 presents with raised blood pressure, raised cholesterol or other risk factors, a referral to her GP for QRISK3 assessment is appropriate.

Medicines Use Reviews and structured medication reviews. When reviewing a woman's medication who has known cardiovascular risk factors but is not on a statin, pharmacists can explore whether this has been discussed with her GP. This is not about second-guessing prescribing decisions — it is about ensuring the conversation has happened.

Counselling on side effects. When a woman is newly prescribed a statin, clear counselling about what to expect, the difference between common early symptoms (which often resolve) and rare serious adverse effects, and the importance of reporting persistent muscle pain rather than simply stopping the medicine, can improve adherence. According to NICE, patients should be advised to report unexplained muscle pain, tenderness or weakness promptly.

Menopause-aware conversations. For women approaching or going through menopause, pharmacists can signpost that cardiovascular risk changes at this life stage and that a fresh risk assessment may be worthwhile — particularly if their last QRISK3 was calculated pre-menopause. PharmSee's salary and jobs data shows growing demand for pharmacists with clinical consultation skills, reflecting the expanding scope of these conversations.

Addressing common patient questions

Pharmacists frequently encounter questions about statins from women patients:

"Do statins work differently in women?" The relative risk reduction is the same. The absolute benefit depends on baseline risk, not sex.

"I've heard statins cause muscle problems — is this worse in women?" Randomised trial data does not show higher rates of confirmed myopathy in women. Some observational studies report higher symptom rates, but these may reflect reporting differences rather than biological differences. The key message: report symptoms to your pharmacist or GP rather than stopping the medicine unilaterally.

"I'm going through menopause — should I be on a statin?" Menopause itself is not an indication for statin therapy, but the lipid changes associated with menopause may shift cardiovascular risk. A QRISK3 reassessment through the GP is the appropriate next step.

"Can I take a statin with HRT?" There is no contraindication to concurrent use of statins and hormone replacement therapy. Both address different aspects of cardiovascular and menopausal health.

What the data does not show

This article draws on published meta-analyses and NICE guidance rather than PharmSee's own dataset. PharmSee does not hold prescribing data — its pharmacy search and job listings cover the workforce and service landscape rather than individual prescribing patterns. The prescribing gap data cited comes from published academic studies using CPRD and QResearch databases.

Sources

• Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of statin therapy in older people: a meta-analysis of individual participant data from 28 randomised controlled trials. The Lancet, 2019.
• Cholesterol Treatment Trialists' Collaboration. Efficacy and safety of LDL-lowering therapy among men and women: meta-analysis of individual data from 174,000 participants in 27 randomised trials. The Lancet, 2015.
• NICE Clinical Guideline 181: Cardiovascular disease: risk assessment and reduction, including lipid modification (updated 2023).
• British Heart Foundation. Women and heart disease statistics, 2024.
• Patel R et al. Sex differences in statin initiation in England. British Journal of General Practice, 2023.