Statins reduce atherosclerotic cardiovascular disease (ASCVD) similarly in women and men. Women develop coronary atherosclerosis more slowly than men. By late middle age, most men have enough atherosclerosis to warrant statin therapy; but in this age range, only about one fourth of women are statin eligible, as implied by coronary artery calcium (CAC). By current guidelines, treatment decisions
... [Show full abstract] depend on multiple risk factor algorithms (e.g., pooled cohort equations [PCEs]). But several studies cast doubt on reliability of available PCEs, especially in women. Many older women have zero CAC, which equates to low risk for ASCVD; these women can delay statin therapy for several years before re-scanning. When CAC is 1-99 Agatston units, risk is only borderline high and statin delay also is an option until re-scanning. When CAC is > 100 Agatston units, risk is high enough to warrant a statin. In most women, CAC is the best guide to treatment decisions. In high-risk women (e.g., diabetes and severe hypercholesterolemia), generally are indicated, but CAC can assist in risk assessment, but other risk factors also can aid in treatment decisions.