Here's something that might surprise you: even after a heart attack, women are significantly less likely than men to receive statin therapy.
This startling statistic begs the question: If women are doing so many things right for our health, what can we do when so many of us still slip through the cracks of the healthcare system?
🧠 The takeaway
Women are up to 30% less likely to receive statin therapy than men—even after a heart attack.
Risk calculators often underestimate women’s long-term risk, because they don’t fully account for female-specific factors like pregnancy complications, early menopause, or autoimmune disease.
Midlife is a turning point. During the menopause transition, LDL cholesterol, blood pressure, visceral fat, and blood sugar often rise — making this a critical window for reassessing heart risk.
❤️ My heart is how old? Over 50% of US adults have hearts that are older than their chronological age. Are you one of them?
The treatment gap is real — and shocking
Heart disease is still the leading cause of death for women (as well as men). Yet we’re less likely to be prescribed statins both for prevention and after a heart attack, even when we clearly meet guideline criteria. “Some studies suggest as much as 30% lower likelihood of receiving statin therapy,” says JoAnn Mason, MD, MPH, DrPH of Harvard University.
Large data registries confirm this, showing women with atherosclerotic cardiovascular disease are less likely to be on any statin or the highest-intensity statin dose compared to men, and less likely to reach LDL targets.
Adding to the concerns are newer reviews that confirm women have been historically under-represented in statin clinical trials, making it harder for clinicians and patients alike to feel confident that risk calculators and treatment pathways fit our biology.
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Our risk calculators may be failing us
One of the reasons statin treatment lags in women has less to do with evidence about the drug and more to do with how we assess risk.
Women’s cardiovascular risk may be underestimated because many of the standard factors don’t fully capture women’s risks, says Manson.
Many of the standard factors ignore female‑specific “risk enhancers” such as:
History of preeclampsia or gestational diabetes
Autoimmune diseases, which are more common in women
Early menopause, especially before age 40, which in some studies nearly doubles the risk of cardiovascular disease
This mismatch leaves many women appearing “low risk” on paper, even as their long-term risk rises.
Menopause is a window of vulnerability and opportunity
If you’re in your 40s, 50s, or 60s, you’re living through a biological turning point for your heart. During the menopause transition, as cycles become irregular and estrogen levels fluctuate, several things tend to happen at once:
LDL (“bad”) cholesterol rises
Abdominal and visceral fat accumulate more easily
Blood pressure and blood sugar creep up
Metabolic syndrome becomes more common
“There are a lot of adverse changes in cardiovascular risk factors,” Manson says. “It’s a critical time period for reassessing risk and lifestyle factors and, in some cases, treating the risk‑factor status.”
Newer research underscores this idea. A 2024 analysis presented at the American College of Cardiology found that after menopause, plaque buildup in women’s coronary arteries accelerates and their cardiovascular risk can “catch up” quickly to that of men with similar profiles. A 2025 review found that the menopause transition is a “window of opportunity” to intervene on rising blood pressure, worsening lipids, and insulin resistance before they translate into heart attacks and strokes.
Manson emphasizes that this time of life isn’t just about numbers. It’s about trajectory. In this window, thoughtful risk assessment and treatment — including statins when appropriate — can make a real impact over the decades ahead.
“The real interest is in lifetime risk and trying to minimize lifetime risk of cardiovascular disease and other major chronic diseases,” says Manson.
What you can do with this information
Manson offers some practical advice that goes beyond just statins (though those are important for the right women).
First, she emphasized what she calls "Life's Essential Eight" — the American Heart Association's framework for cardiovascular health. This includes monitoring and managing:
Physical activity (including strength training)
Diet quality
Sleep (7-9 hours per night)
Blood pressure
Cholesterol levels
Blood sugar
Body weight
Smoking status
Then, consider this your reminder to:
Talk to your doctor about your complete cardiovascular risk profile, including any pregnancy complications, autoimmune conditions, or early menopause
Ask specifically about whether you're a candidate for statin therapy, and if so, whether you're on the appropriate intensity
Advocate for yourself if you feel your concerns aren't being taken seriously
Focus on the fundamentals: regular physical activity (including strength training), healthy eating, good sleep, and stress management
Statins do matter, but not in a vacuum. The real opportunity lies in recognizing that standard risk calculators often miss women’s true risk, approaching midlife as a chance for proactive prevention, and not letting gender bias in treatment decisions persist.
Heart health isn’t one-size-fits-all. For women — especially those 50 and up — it’s time our prevention strategies reflect that.
Go deeper on women’s longevity with Dr. Dean Ornish.
If this issue sparked questions about your own heart health, you’ll love what we’re building at the Livelong Women’s Health Summit — a gathering designed for curious, thoughtful women who want evidence-based tools for aging well.
From heart and metabolic health to strength, hormones, and prevention, the Summit brings together experts like Dr. Dean Ornish and women who are ready to take their health seriously — without fear-based messaging.
Save your seat and be part of the next chapter in women’s health. Use the code TIFFANY to get $50 off your ticket.
Want to help shape the future of women’s health?
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If you care about longevity, prevention, and changing how women’s health is discussed, we’d love to hear from you.
If your work supports women’s long-term health—through science-backed products, services, or education—we’re currently welcoming vendors and partners for the Livelong ecosystem and upcoming events.
Our community values credibility, transparency, and impact over trends.
Join the conversation.
The Livelong Women’s Lab is where these topics go deeper — real conversations about heart health, midlife changes, prevention, and what actually works as we age.
If you’re looking for a smart, supportive space to ask questions and learn alongside other women, you’re welcome here.
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