Statins May Reduce Risk for Venous Thromboembolism in Patients With Cardiovascular Disease
By Kristina Rebelo
Medscape Medical News
November 10, 2009 (San Diego, California) — Investigators were surprised to find an apparent reduction in risk for venous or pulmonary thromboembolism in patients admitted to the hospital with myocardial infarction (MI) or stroke who were treated with high-dose statin therapy, they told attendees here at CHEST 2009: American College of Chest Physicians Annual Meeting.
The findings were presented by lead author Danai Khemasuwan, MD, a third-year resident in internal medicine at Albert Einstein Medical Center in Philadelphia, Pennsylvania.
"I was surprised at the outcome because statins are a preventive measure for myocardial infarction and stroke, which is disease in the arterial circulation, but this evidence shows that statins may affect the disease in the venous circulation as well," Dr. Khemasuwan told Medscape Pulmonary Medicine in an interview after his presentation.
Dr. Khemasuwan reported that he and his colleagues looked at the relation between the use of statins in patients with a history of atherosclerosis and its influence on the development of venous thromboembolism (VTE). This was a retrospective study of 593 patients (52% female; 77% African American; mean age, 67.8?years) who had been admitted to his institution for either an MI or ischemic stroke. Of this group, 73% (n?= 433) were taking a statin and had an overall occurrence of VTE of 13% (n?= 77).
The specific results that impressed Dr. Khemasuwan were that, among patients taking statins, 8.3% (36 of 433) developed a clinical VTE, compared with 26.3% (42 of 160) of those not taking a statin (odds ratio [OR], 0.25; 95% confidence interval [CI], 0.16?- 0.42; P?< .001), meaning that nonusers were 3 times more likely to develop VTE than users of statin therapy.
Even after controlling for typical VTE risk factors, such as smoking, history of cancer, and immobilization, statin use was associated with a decreased risk of developing a clot (OR, 0.27; 95% CI, 0.16?- 0.44; P?< .001].
"I did the subgroup analysis and showed that the patients on higher doses of statins (>40?mg/day) [OR, 0.32; 95% CI, 0.12?- 0.82; P?= .017] have an even smaller chance of developing VTE, compared with a standard dose [OR, 0.48; 95% CI, 0.29?- 0.78; P = .003]," said Dr. Khemasuwan.
The investigators also looked at patients with a history of cancer and found a similar protective effect against VTE with statin therapy. He said he didn't want to speculate on the efficacy of statins in other high-risk groups, such as surgical patients, but acknowledged that further investigation is warranted.
Commenting on Dr. Khemasuwan's study, ACCP president Kalpalatha Guntupalli, MD, FCCP, professor and chief of the Pulmonary/Critical Care and Sleep Section at the Baylor College of Medicine in Houston, Texas, told Medscape Pulmonary Medicine that "venous thromboembolism leads to significant morbidity, mortality, and hospital costs in Americans each year. Although more research is needed, statins may prove effective in helping to reduce the incidence of VTE in specific patient populations."
The study did not receive commercial support. Dr. Khemasuwan and Dr. Guntupalli have disclosed no relevant financial relationships.
CHEST 2009: American College of Chest Physicians Annual Meeting: Abstract 598. Presented November?3, 2009.
