Do statins protect against upper gastrointestinal bleeding?
OBJECTIVE
Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other antithrombotic drugs.


METHODS
A population-based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB from a hospital during the period 1995 to 2006. Age- and gender-matched controls (10 for each case) (n = 36 502) were selected by a risk set sampling. Data on all subjects' drug exposure and past medical history were retrieved from a prescription database and from the County's patient register. Confounders were controlled by conditional logistic regression.


RESULTS
The adjusted odds ratios (ORs) associating use of statins with UGB were 0.94 (0.78-1.12) for current use, 1.40 (0.89-2.20) for recent use and 1.42 (0.96-2.10) for past use. The lack of effect was consistent across most patient subgroups, different cumulative or current statin doses and different statin substances. In explorative analyses, a borderline significant protective effect was observed for concurrent users of low-dose aspirin [OR 0.43 (0.18-1.05)].


CONCLUSIONS
Statins do not prevent UGB, except possibly in users of low-dose aspirin.
Research Unit of Clinical Pharmacology, University of Southern Denmark, Odense, Denmark. egulmez@health.sdu.dk
Sinem Ezgi
SE
Gulmez
Annmarie Touborg
AT
Lassen
Claus
C
Aalykke
Michael
M
Dall
Alin
A
Andries
Birthe Søgaard
BS
Andersen
Jane Møller
JM
Hansen
Morten
M
Andersen
Jesper
J
Hallas
D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000009:adverse effects*; D016022:Case-Control Studies; D003718:Denmark / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin