title: The association of statin therapy with the risk of recurrent venous thrombosis.
abstract: Essentials A lowered risk of recurrent venous thrombosis (VT) with statin treatment is controversial. Among observational inception cohort of 2,798 adults with incident VT, 457 had recurrent VT. Time-to-event models with time-varying statin use and adjustment for potential confounders was used for analysis. Compared to nonuse, current statin use was associated with 26% lower risk of recurrent VT. Click to hear Prof. Büller's perspective on Anticoagulant Therapy in the Treatment of Venous Thromboembolism
  
  
  
  Background Meta-analyses of randomized controlled trials suggest that treatment with hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins) lowers the risk of incident venous thrombosis (VT), particularly among those without prevalent clinical cardiovascular disease (CVD). Whether this is true for the prevention of recurrent VT is debated. We used an observational inception cohort to estimate the association of current statin use with the risk of recurrent VT. Methods and Results The study setting was a large healthcare organization with detailed medical record and pharmacy information at cohort entry and throughout follow-up. We followed 2798 subjects 18-89 years of age who experienced a validated incident VT between January 1, 2002, and December 31, 2010, for a first recurrent VT, validated by medical record review. During follow-up, 457 (16%) developed a first recurrent VT. In time-to-event models incorporating time-varying statin use and adjusting for potential confounders, current statin use was associated with a 26% lower risk of recurrent VT: hazard ratio 0.74, 95% confidence interval 0.59-0.94. Among cohort members free of CVD (n = 2134), current statin use was also associated with a lower risk (38%) of recurrent VT: hazard ratio 0.62, 95% confidence interval 0.45-0.85. We found similar results when restricting to new users of statins and in subgroups of different statin types and doses. Conclusions In a population-based cohort of subjects who had experienced an incident VT, statin use, compared with nonuse, was associated with a clinically relevant lower risk of recurrent VT. These findings suggest a potential secondary benefit of statins among patients who have experienced an incident VT.
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.|Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.|Seattle Epidemiologic Research and Information Center, Veterans Affairs Office of Research and Development, Seattle, WA, USA.
authors.forename: N L
authors.initials: NL
authors.lastname: Smith
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: L B
authors.initials: LB
authors.lastname: Harrington
authors.affiliation: Division of Angiology and Haemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Blondon
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: K L
authors.initials: KL
authors.lastname: Wiggins
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Floyd
authors.affiliation: Department of Medicine, University of Washington, Seattle, WA, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Sitlani
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: B
authors.initials: B
authors.lastname: McKnight
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.
authors.forename: E B
authors.initials: EB
authors.lastname: Larson
authors.affiliation: Departments of Clinical Epidemiology and of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: F R
authors.initials: FR
authors.lastname: Rosendaal
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.|Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.|Department of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: S R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Department of Epidemiology, University of Washington, Seattle, WA, USA.|Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA.|Department of Medicine, University of Washington, Seattle, WA, USA.|Department of Health Services, University of Washington, Seattle, WA, USA.
authors.forename: B M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000628:therapy; D003276:Contraceptives, Oral / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000188:drug therapy; D012008:Recurrence; D012307:Risk Factors; D013927:Thrombosis / Q000188:drug therapy; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000378:metabolism / Q000517:prevention & control*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D003276:Contraceptives, Oral; D004967:Estrogens; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: cohort studies; hydroxymethylglutaryl-CoA reductase inhibitors; pharmacoepidemiology; recurrence; venous thrombosis