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Statins unlikely to protect against VTE
Statins offered no protective effect against venous thromboembolic events, according to results of a meta-analysis.
The JUPITER trial, a randomized controlled study that found the statin rosuvastatin halved the risk of VTE in apparently healthy adults, served as the motivation for the current meta-analysis.
In the current study, researchers reviewed studies found in Medline, Embase and Cochrane Central databases through March 2012. Their analysis included randomized trials that compared statin use with no statin use, or high-dose statin use with standard dose. All trials involved more than 100 patients and reported data for at least 6 months of follow-up.
The researchers contacted investigators from the studies they analyzed and requested unpublished information regarding VTE.
The final analysis included 29 trials that involved 146,353 patients. Of those trials, 22 compared statin use vs. no statin use (n=105,759), and seven compared high-dose statin use vs. standard-dose use (n=40,594).
In the studies that compared statin use with no use, researchers found no significant reduction in risk of VTE (465 [0.9%] for statins vs. 521 [1%] for controls; OR=0.89; 95% CI, 0.78-1.01). Moreover, researchers observed no evidence of heterogeneity between effects on deep vein thrombosis (266 for statins vs. 311 for controls; OR=0.85; 95% CI, 0.72-1.01) and effects on pulmonary embolism (205 for statins vs. 222 for controls; OR=0.92; 95% CI, 0.76-1.12).
Similarly, a higher dose of statins did not appear to reduce risk for VTE compared with standard dose, researchers said. There were 198 events (1%) in the high-dose group and 202 events (1%) in the standard-dose group (OR=0.98; 95% CI, 0.80-1.20).
“This study provides a more detailed assessment of the potential effects of statins (or higher dose statins) on venous thromboembolic events than has previously been possible,” the researchers wrote. “We were unable to confirm the large proportional reduction in risk suggested by some previous studies. However, a more modest but perhaps clinically worthwhile reduction in venous thromboembolic events in some or all types of [patients] cannot be ruled out.”
In an accompanying editorial, Frits Rosendaal, MD, PhD, of the department of clinical epidemiology at Leiden University Medical Center in The Netherlands, said that although the study cannot provide definite answers to the statin question, some tentative conclusions can be drawn.
“For the association between statins and venous thrombosis, the methodologically strongest analysis shows at most a very small effect,” Rosendaal said. “Secondly, if we do not wish to discard the possibility of a beneficial effect for the whole class, any such effects are limited to rosuvastatin.”
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