Statin use may reduce risk of venous thromboembolism in women taking hormone therapy

1. In this case-control study, the use of statins in menopausal women concurrently with hormone therapy (HT) significantly reduced the risk of VTE. 

2. The response was dose-dependent, with high-intensity statins providing a higher reduction in VTE risk compared with low- to -medium intensity statins. 

Evidence Rating Level: 3 (Average)

Menopausal symptoms can have debilitating impacts on women’s quality of life, and although hormone therapy (HT) can be effective, concerns surrounding increased risk for complications (such as the doubled risk for VTE) are a barrier to the initiation of HT. The anti-inflammatory and antithrombotic benefits of statins in reducing the risk for VTE have been established, but their potential role in mediating VTE risk for postmenopausal women on HT has not been established in the US, nor has it been re-established in the recently changing landscape of HT (e.g., there has been a decrease in estrogen products use in the past decade, and research has not included women on higher-risk combined hormonal contraceptives). The current case-control study analyzed databases of over 223,000 women aged 50 to 64 (mean [SD] age, 57.5 [4.4] years), with controls matching VTE cases in a 10:1 ratio. It was found that overall, recent HT exposure was associated with 51% increased risk for VTE compared to those with no recent HT (OR, 1.51; 95% CI, 1.43-1.60). Current statin use was associated with a decreased risk (12%) of VTE for women on HT compared to those using no statins (OR, 0.88; 95% CI, 0.84-0.93). Overall, individuals taking HT with statins had an 18% lower risk of VTE than those on HT without statins, and there was a dose-dependent response where high-intensity statin use (atorvastatin ≥40 mg or rosuvastatin ≥20 mg) was associated with a 31% reduction in VTE risk compared to low- to medium- intensity statin therapy which (16% decreased risk). These results indicate that HT may not be contraindicated in women taking statins and suggest that they may actually counteract some of the associated risks of VTE and cardiovascular complications while on HT.

Click to read the study in JAMA Network Open

Image: PD

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