Statin use and venous thromboembolism in cancer: A large, active comparator, propensity score matched cohort study

摘要

Abstract Background Statins have been shown to have a protective effect for venous thromboembolism (VTE) in the general population. This study sought to assess the association between statins and the risk for cancer-associated deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods Patients with newly diagnosed cancer were followed for up to one year in a healthcare claims database (2010?2013). Three treatment groups included statin users, non-statin cholesterol lowering medication users, and an untreated group with pre-existing indications for statin therapy (hyperlipidemia, diabetes, or heart disease). Propensity score matched groups were compared using competing risks survival models for DVT and PE outcomes reporting the hazard ratios (HR) between the treatment groups. Sensitivity analyses assessed the influence of age and individual medications. Results The total cohort included 170,459 patients, which, after matching, were similar on baseline characteristics. The overall model showed a statistically significant protective effect for statins compared to no treatment attributed only to leukemia for DVT (HR=0.77, 95% CI 0.61–0.99) and colorectal cancers for PE (HR=0.80, 95% CI 0.64–0.99) in stratified analyses. There were generally no differences in outcomes between statins and non-statins and no individual statin use showed results different from the class effect. Conclusions In this propensity score matched sample of patients with cancer, statins were shown to have a small protective effect in some cancers for DVT or PE compared to no treatment and little difference compared to an active control group. The lack of effect was consistent across statins and was also not found for any of the sensitivity analyses included. Highlights ? Statins showed a small overall protective effect against venous thromboembolism only in leukemia and colorectal cancers ? Overall, there were no differences between statin therapy and non-statin therapy as an active comparator ? Findings were robust to multiple sensitivity analyses including age and individual statin stratification