Key result
Statin therapy is linked to a ~50% reduction in recurrent PE during and after stopping VKAs.
Why the study?
Statins reduce the incidence of a first VTE episode, but data on their effects on recurrent pulmonary embolism risk after a previous episode are lacking.
Does statin therapy reduce the risk of recurrent pulmonary embolism in patients with a previous acute episode of PE?
Cohort
Does statin therapy reduce the risk of recurrent pulmonary embolism in patients with a previous acute episode of PE?
Statin treatment is associated with a 50% reduced risk of recurrent pulmonary embolism in patients with a prior acute PE, irrespective of concurrent vitamin K antagonist treatment.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“So statins have no beneficial effect, but also no harmful effect.”
“These results provide an extensive body of evidence on the clinical benefit of statin[s] in the occurrence of VTE and may support a true protective effect.”
“Stories too good to be true may nevertheless be true, but need to be approached with ample skepticism. Over the years, beneficial effects have been attributed to statins that go beyond lipid-lowering... one may argue that if many cures are attributed to a single drug, it may be ineffective—and non-causal explanations should be sought.”
Statin therapy was associated with lower recurrent PE risk; hypothesis-generating for secondary prevention and requires RCT confirmation before practice change.
AIMS: Patients with idiopathic venous thromboembolism (VTE) have a high recurrence risk during and after stopping anticoagulant treatment. Several studies suggest that treatment with statins reduces the incidence of a first episode of VTE, but data on the effects in patients with a previous episode are lacking. We examined the effect of statin therapy on the risk of recurrent pulmonary embolism (PE). METHODS AND RESULTS: Using the PHARMO Record Linkage System, a Dutch population-based registry of pharmacy records linked with hospital discharge records, patients hospitalized with an acute episode of PE were identified between 1998 and 2008. Prescription-based use of statins and vitamin K antagonist (VKA) were identified starting at hospital discharge and during follow-up. The association between statin use (time-varying) and the incidence of recurrences, cardiovascular events, and death was assessed using Cox regression analysis. The mean (standard deviation) age was 61 (17) years. The median (range) duration of VKA treatment after acute PE was 199 (45-3793) days. Twenty-four per cent of the patients (n = 737) had at least one prescription of statins during the follow-up period and the median duration of statin therapy was 1557 (5-4055) days. During a median follow-up of 1529 (1-4155) days, 285 (9.2%) patients experienced a recurrence. Treatment with statins was associated with a reduced risk of recurrent PE [adjusted hazard ratio (HR) 0.50, 95% CI: 0.36-0.70], both during and after stopping VKA treatment. A dose-response relationship was shown for potency, with the largest reduction in those with the most potent statins. Finally, statin treatment also reduced the risk for cardiovascular events and all-cause mortality. CONCLUSION: Statin treatment decreases the risk of recurrent PE, irrespective of VKA treatment. Treatment with statins may be an attractive alternative for anticoagulant treatment in the long-term treatment of PE.
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Biere‐Rafi et al. (2013) conducted a cohort in acute episode of pulmonary embolism. Statin therapy vs. No statin therapy was evaluated on recurrent pulmonary embolism (PE) (adjusted HR 0.50, 95% CI 0.36-0.70). Statin therapy was associated with a reduced risk of recurrent pulmonary embolism (adjusted HR 0.50; 95% CI 0.36-0.70), both during and after stopping vitamin K antagonist treatment.
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