Initiation of statins and risk of venous thromboembolism: Population-based matched cohort study

Nils Skajaa, Szimonetta K. Szépligeti, Erzsébet Horváth-Puhó, Waleed Ghanima, John Bjarne Hansen, Henrik Toft Sørensen

Research output: Article

Abstract

Background: The effects of statins in prevention of venous thromboembolism (VTE) is not well established. Objectives: To examine the risks of first-time VTE in a cohort of patients initiating statin treatment and in a matched general population comparison cohort. Methods: We conducted a nationwide, population-based, matched cohort study based on data from Danish health registries. The study period was 1 January 2005–31 December 2015. We identified statin initiators (without VTE, myocardial infarction, or ischemic stroke) and sex-, age-, and calendar year-matched (1,3) individuals from the general population (without statin use, VTE, myocardial infarction, or ischemic stroke). We computed cumulative risks and comorbidity-adjusted hazard ratios (HRs) of VTE, myocardial infarction, and ischemic stroke. Results: Among 601,011 statin initiators and 1,803,033 matched population cohort members during 2005–2015, the cumulative risk after 11 years was 2.8% for VTE (both cohorts), 4.7% vs. 2.9% for myocardial infarction, and 7.1% vs. 5.2 for ischemic stroke. After adjustment, statin use was associated with a slightly decreased risk of VTE (adjusted HR: 0.95 [95% CI: 0.92–0.97]), driven by a reduced risk of unprovoked VTE (adjusted HR: 0.92 [95% CI: 0.89–0.95]). The reduced risks of VTE were more pronounced among patients who had an imaging examination performed. The adjusted HRs were elevated for myocardial infarction and ischemic stroke. Conclusion: Statin initiation was associated with a reduced risk of VTE, with no indication of a healthy-user effect. Based on available evidence, statins have weak thromboprophylactic effects.

Original languageEnglish
Pages (from-to)99-104
Number of pages6
JournalThrombosis research
Volume184
DOIs
Publication statusPublished - dec. 2019

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Venous Thromboembolism
Cohort Studies
Population
Stroke
Myocardial Infarction
Registries
Comorbidity

ASJC Scopus subject areas

  • Hematology

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Initiation of statins and risk of venous thromboembolism : Population-based matched cohort study. / Skajaa, Nils; Szépligeti, Szimonetta K.; Horváth-Puhó, Erzsébet; Ghanima, Waleed; Hansen, John Bjarne; Sørensen, Henrik Toft.

In: Thrombosis research, Vol. 184, 12.2019, p. 99-104.

Research output: Article

Skajaa, Nils ; Szépligeti, Szimonetta K. ; Horváth-Puhó, Erzsébet ; Ghanima, Waleed ; Hansen, John Bjarne ; Sørensen, Henrik Toft. / Initiation of statins and risk of venous thromboembolism : Population-based matched cohort study. In: Thrombosis research. 2019 ; Vol. 184. pp. 99-104.
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abstract = "Background: The effects of statins in prevention of venous thromboembolism (VTE) is not well established. Objectives: To examine the risks of first-time VTE in a cohort of patients initiating statin treatment and in a matched general population comparison cohort. Methods: We conducted a nationwide, population-based, matched cohort study based on data from Danish health registries. The study period was 1 January 2005–31 December 2015. We identified statin initiators (without VTE, myocardial infarction, or ischemic stroke) and sex-, age-, and calendar year-matched (1,3) individuals from the general population (without statin use, VTE, myocardial infarction, or ischemic stroke). We computed cumulative risks and comorbidity-adjusted hazard ratios (HRs) of VTE, myocardial infarction, and ischemic stroke. Results: Among 601,011 statin initiators and 1,803,033 matched population cohort members during 2005–2015, the cumulative risk after 11 years was 2.8{\%} for VTE (both cohorts), 4.7{\%} vs. 2.9{\%} for myocardial infarction, and 7.1{\%} vs. 5.2 for ischemic stroke. After adjustment, statin use was associated with a slightly decreased risk of VTE (adjusted HR: 0.95 [95{\%} CI: 0.92–0.97]), driven by a reduced risk of unprovoked VTE (adjusted HR: 0.92 [95{\%} CI: 0.89–0.95]). The reduced risks of VTE were more pronounced among patients who had an imaging examination performed. The adjusted HRs were elevated for myocardial infarction and ischemic stroke. Conclusion: Statin initiation was associated with a reduced risk of VTE, with no indication of a healthy-user effect. Based on available evidence, statins have weak thromboprophylactic effects.",
keywords = "New-user design, Pharmacoepidemiology, Pleiotropic effects, Prevention, Statins, Venous thromboembolism",
author = "Nils Skajaa and Sz{\'e}pligeti, {Szimonetta K.} and Erzs{\'e}bet Horv{\'a}th-Puh{\'o} and Waleed Ghanima and Hansen, {John Bjarne} and S{\o}rensen, {Henrik Toft}",
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TY - JOUR

T1 - Initiation of statins and risk of venous thromboembolism

T2 - Population-based matched cohort study

AU - Skajaa, Nils

AU - Szépligeti, Szimonetta K.

AU - Horváth-Puhó, Erzsébet

AU - Ghanima, Waleed

AU - Hansen, John Bjarne

AU - Sørensen, Henrik Toft

PY - 2019/12

Y1 - 2019/12

N2 - Background: The effects of statins in prevention of venous thromboembolism (VTE) is not well established. Objectives: To examine the risks of first-time VTE in a cohort of patients initiating statin treatment and in a matched general population comparison cohort. Methods: We conducted a nationwide, population-based, matched cohort study based on data from Danish health registries. The study period was 1 January 2005–31 December 2015. We identified statin initiators (without VTE, myocardial infarction, or ischemic stroke) and sex-, age-, and calendar year-matched (1,3) individuals from the general population (without statin use, VTE, myocardial infarction, or ischemic stroke). We computed cumulative risks and comorbidity-adjusted hazard ratios (HRs) of VTE, myocardial infarction, and ischemic stroke. Results: Among 601,011 statin initiators and 1,803,033 matched population cohort members during 2005–2015, the cumulative risk after 11 years was 2.8% for VTE (both cohorts), 4.7% vs. 2.9% for myocardial infarction, and 7.1% vs. 5.2 for ischemic stroke. After adjustment, statin use was associated with a slightly decreased risk of VTE (adjusted HR: 0.95 [95% CI: 0.92–0.97]), driven by a reduced risk of unprovoked VTE (adjusted HR: 0.92 [95% CI: 0.89–0.95]). The reduced risks of VTE were more pronounced among patients who had an imaging examination performed. The adjusted HRs were elevated for myocardial infarction and ischemic stroke. Conclusion: Statin initiation was associated with a reduced risk of VTE, with no indication of a healthy-user effect. Based on available evidence, statins have weak thromboprophylactic effects.

AB - Background: The effects of statins in prevention of venous thromboembolism (VTE) is not well established. Objectives: To examine the risks of first-time VTE in a cohort of patients initiating statin treatment and in a matched general population comparison cohort. Methods: We conducted a nationwide, population-based, matched cohort study based on data from Danish health registries. The study period was 1 January 2005–31 December 2015. We identified statin initiators (without VTE, myocardial infarction, or ischemic stroke) and sex-, age-, and calendar year-matched (1,3) individuals from the general population (without statin use, VTE, myocardial infarction, or ischemic stroke). We computed cumulative risks and comorbidity-adjusted hazard ratios (HRs) of VTE, myocardial infarction, and ischemic stroke. Results: Among 601,011 statin initiators and 1,803,033 matched population cohort members during 2005–2015, the cumulative risk after 11 years was 2.8% for VTE (both cohorts), 4.7% vs. 2.9% for myocardial infarction, and 7.1% vs. 5.2 for ischemic stroke. After adjustment, statin use was associated with a slightly decreased risk of VTE (adjusted HR: 0.95 [95% CI: 0.92–0.97]), driven by a reduced risk of unprovoked VTE (adjusted HR: 0.92 [95% CI: 0.89–0.95]). The reduced risks of VTE were more pronounced among patients who had an imaging examination performed. The adjusted HRs were elevated for myocardial infarction and ischemic stroke. Conclusion: Statin initiation was associated with a reduced risk of VTE, with no indication of a healthy-user effect. Based on available evidence, statins have weak thromboprophylactic effects.

KW - New-user design

KW - Pharmacoepidemiology

KW - Pleiotropic effects

KW - Prevention

KW - Statins

KW - Venous thromboembolism

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DO - 10.1016/j.thromres.2019.11.003

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