Statins could mitigate clotting risk in women at menopausal age on hormone therapy
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Key takeaways:
- Statins may lower venous blood clot risk in perimenopausal women with recent hormone therapy exposure.
- Likelihood of VTE was reduced further with greater statin intensity.
Statin therapy could lower the odds of blood clot formation conferred by hormone therapy in perimenopausal women, according to a case-control study published in JAMA Network Open.
“Menopause-associated symptoms (eg, hot flashes, vaginal dryness, disruptions in sleep patterns and cognitive changes) are common and can affect quality of life. Hormone therapy (HT) is an effective treatment for many of these symptoms. However, concerns regarding increased risk of venous thromboembolism, stroke or myocardial infarction can prevent many symptomatic women from receiving HT,” John W. Davis, BA, of the department of population health science at the University of Texas Medical Branch (UTMB) School of Public and Population Health, and colleagues wrote. “This study explored whether statin therapy mediates VTE risk in U.S. women aged 50 to 64 years exposed to exogenous hormones.”
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Using the Optum deidentified Clinformatics Data Mart database, Davis and colleagues identified 223,949 perimenopausal women (mean age, 58 years), of whom 20,359 patients with VTE (cases) met inclusion criteria and were matched to 203,590 controls.
Overall, 8.73% of the cohort had recent HT exposure and 16.18% had current statin therapy exposure.
Adjusted models controlled for covariates including for region of residence, age, history of cancer except for nonmelanoma skin cancer, history of prothrombotic conditions, recent varicose veins within the previous year, hospitalization or trauma within 30 days and prior CAD, stroke, dyslipidemia and smoking in the past year.
After adjustment, individuals with recent exposure to HT had a 51% greater odds of VTE compared with those with no recent exposure (OR = 1.51; 95% CI, 1.43-1.6).
Compared with perimenopausal women not taking HT or statins, the odds of VTE were greater for those taking HT but not statins (OR = 1.53; 95% CI, 1.44-1.63) and those on concomitant hormone and statin therapy (OR = 1.25; 95% CI, 1.1-1.43).
However, the odds of VTE were lower among women taking statins without concomitant HT (OR = 0.89; 95% CI, 0.85-0.94) compared with women taking neither, according to the study.
Moreover, concomitant hormone and statin therapy was associated with an 18% lower odds of VTE among perimenopausal women compared with those on HT without statins (OR = 0.82; 95% CI, 0.71-0.94), and there was greater risk reduction with higher-intensity statins (OR for low- and moderate-intensity statin therapy = 0.84; 95% CI, 0.73-0.98; OR for high-intensity statin therapy = 0.69; 95% CI, 0.5-0.95).
“Although women who are at higher cardiovascular risk may take statins, and thus may seem unlikely candidates for HT, statin therapy appears to mitigate some of the risk from HT,” the researchers wrote. “HT may not be contraindicated in women who are candidates for statin therapy. These findings suggest that statins may improve the HT risk-benefit profile for women with perimenopausal symptoms. An randomized controlled trial evaluating the absolute risk of thrombosis with concomitant statin therapy is needed to elucidate the full safety profile.”
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