Statins and primary prevention of venous thromboembolism: a systematic review and meta-analysis

Setor Kunutsor*, Samuel Seidu, Kamlesh Khunti

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

53 Citations (Scopus)
534 Downloads (Pure)

Abstract

Background
Statins have been suggested to have a protective effect on venous thromboembolism (which includes deep vein thrombosis and pulmonary embolism), but the evidence is uncertain. We sought to evaluate the extent to
which statins are associated with first venous thromboembolism events.

Methods
We did a systematic review and meta-analysis of observational cohort studies and randomised controlled trials (RCTs). Relevant studies that reported associations between statins and first venous thromboembolism outcomes were identified from MEDLINE, Embase, Web of Science, Cochrane Library, and a manual search of bibliographies for studies published up until July 18, 2016, and from email correspondence with investigators. Observational cohorts that assessed the association of statin use with venous thromboembolism, deep vein thrombosis, or pulmonary embolism in adults were included, as were intervention studies that assessed the effects of statin therapy compared with a placebo or no treatment and collected data on venous thromboembolism, deep vein thrombosis, or pulmonary embolism outcomes. Studies that compared statins with another statin or lipid-lowering agent were excluded. Study specific relative risks (RRs) were aggregated using random-effects models and were grouped by study-level characteristics.

The review has been registered with PROSPERO, number CRD42016035622.


Findings
36 eligible studies (13 cohort studies comprising 3 148 259 participants and 23 RCTs of statins vs placebo or no treatment comprising 118 464 participants) were included. In observational studies, the pooled RR for venous thromboembolism was 0·75 (95% CI 0·65–0·87) when statin use with was compared with no statin use. This association remained consistent when grouped by various study-level characteristics. In RCTs, the RR for venous
thromboembolism was 0·85 (0·73–0·99) when statin therapy was compared with placebo or no treatment. Subgroup analyses suggested significant differences in the effect of statins by type of statin, with rosuvastatin having the lowest risk on venous thromboembolism compared to other statins 0·57 (0·42–0·75). There was no evidence of an effect of statin use on pulmonary embolism.

Interpretation
Available evidence from observational and intervention studies suggest a beneficial effect of statin use on venous thromboembolism. In intervention studies, therapy with rosuvastatin significantly reduced venous
thromboembolism compared with other statins. Further evidence is however needed to validate these findings.
Original languageEnglish
Pages (from-to)e83-e93
Number of pages11
JournalLancet Haematology
Volume4
Issue number2
Early online date13 Jan 2017
DOIs
Publication statusPublished - Feb 2017

Keywords

  • statin therapy
  • Venous Thromboembolism
  • Pulmonary Embolism
  • deep vein thrombosis
  • Primary Prevention
  • Systematic review
  • Meta-Analysis

Fingerprint

Dive into the research topics of 'Statins and primary prevention of venous thromboembolism: a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this