Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
Thromb Res. 2019 Dec;184:99-104. doi: 10.1016/j.thromres.2019.11.003. Epub 2019 Nov 6.
The effects of statins in prevention of venous thromboembolism (VTE) is not well established.
To examine the risks of first-time VTE in a cohort of patients initiating statin treatment and in a matched general population comparison cohort.
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.
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.
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.
他汀类药物在预防静脉血栓栓塞症（VTE）中的作用尚未得到充分证实。
在接受他汀类药物治疗的患者队列和匹配的一般人群对照队列中，研究首次发生 VTE 的风险。
我们进行了一项基于丹麦健康登记数据的全国性、基于人群的匹配队列研究。研究期间为 2005 年 1 月 1 日至 2015 年 12 月 31 日。我们从一般人群中确定了未发生 VTE、心肌梗死或缺血性卒中的他汀类药物初治者（无他汀类药物使用、VTE、心肌梗死或缺血性卒中），并按性别、年龄和日历年份进行了 1:3 匹配（无他汀类药物使用、VTE、心肌梗死或缺血性卒中）。我们计算了 VTE、心肌梗死和缺血性卒中的累积风险和调整合并症后的风险比（HR）。
在 2005 年至 2015 年期间，601011 名他汀类药物初治者和 1803033 名匹配的人群队列成员中，11 年后的 VTE 累积风险为 2.8%（两个队列），心肌梗死为 4.7% vs. 2.9%，缺血性卒中为 7.1% vs. 5.2%。调整后，他汀类药物的使用与 VTE 的风险略有降低相关（调整后的 HR：0.95 [95%CI：0.92-0.97]），这主要归因于未诱发 VTE 的风险降低（调整后的 HR：0.92 [95%CI：0.89-0.95]）。在接受影像学检查的患者中，VTE 的风险降低更为明显。心肌梗死和缺血性卒中的调整后 HR 升高。
他汀类药物的初始使用与 VTE 风险降低相关，没有健康使用者效应的迹象。根据现有证据，他汀类药物具有较弱的抗血栓形成作用。
