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Statin Treatment and the Risk of Recurrent Pulmonary Embolism
Study Questions:
What is the effect of statin therapy on the risk of recurrent pulmonary embolism (PE)?
Methods:
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.
Results:
The mean (standard deviation) age was 61 (17) years. The median (range) duration of VKA treatment after acute PE was 199 (45-3,793) days. Approximately 24% 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 1,557 (5-4,055) days. During a median follow-up of 1,529 (1-4,155) 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% confidence interval [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.
Conclusions:
The authors concluded that statin treatment decreases the risk of recurrent PE, irrespective of VKA treatment.
Perspective:
In this analysis based on over 3,000 patients with a first episode of PE and a median follow-up of 1,529 days, statin therapy was associated with about a 50% reduction in the occurrence of recurrent PE, and this beneficial effect was present during and after VKA treatment. Furthermore, there was an inverse dose–response relationship between potency of statin therapy and the incidence of recurrences. Finally, during follow-up, statin therapy was associated with a 30% reduction in cardiovascular events and a 50% reduction in all-cause mortality in patients with PE. It appears that statins may be effective as an adjunctive therapy to anticoagulant drugs in patients with PE; however, this needs to be confirmed in prospective, randomized clinical trials.
Keywords: Recurrence, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Pulmonary Embolism
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