背景:他汀类药物在预防静脉血栓栓塞症(VTE)中的作用尚不明确。
目的:在开始他汀类药物治疗的患者队列和匹配的一般人群比较队列中,研究首次静脉血栓栓塞的风险。
方法:我们在全国范围内进行了一次,以人口为基础,基于丹麦卫生登记处数据的配对队列研究。研究期间为2005年1月1日至2015年12月31日。我们确定了他汀类药物引发剂(没有静脉血栓栓塞,心肌梗塞,或缺血性中风)和性别-,年龄-,和来自普通人群的日历年匹配(1,3)个体(不使用他汀类药物,VTE,心肌梗塞,或缺血性中风)。我们计算了静脉血栓栓塞的累积风险和合并症调整后的风险比(HRs),心肌梗塞,和缺血性中风。
结果:在2005-2015年期间的601,011名他汀类药物发起者和1,803,033名匹配人群队列成员中,VTE(两个队列)11年后的累积风险为2.8%,4.7%与心肌梗死2.9%,和7.1%与5.2为缺血性卒中。调整后,他汀类药物的使用与VTE的风险略有降低相关(调整后的HR:0.95[95%CI:0.92-0.97]),由无源性静脉血栓栓塞风险降低驱动(调整后HR:0.92[95%CI:0.89-0.95])。在进行影像学检查的患者中,VTE风险的降低更为明显。心肌梗死和缺血性卒中的调整后HR升高。
结论:开始使用他汀类药物与降低VTE风险相关,没有迹象表明有健康的用户效应。根据现有证据,他汀类药物的血栓预防作用较弱。
BACKGROUND: The effects of statins in prevention of venous thromboembolism (VTE) is not well established.
OBJECTIVE: To examine the risks of first-time VTE in a cohort of patients initiating statin treatment and in a matched general population comparison cohort.
METHODS: We conducted a nationwide, population-based, matched cohort
study based on data from Danish health registries. The
study period was 1 January 2005-31 December 2015. We identified statin initiators (without VTE, myocardial infarction, or ischemic stroke) and sex-, age-, and calendar year-matched (1,3) individuals from the general population (without statin use, VTE, myocardial infarction, or ischemic stroke). We computed cumulative risks and comorbidity-adjusted hazard ratios (HRs) of VTE, myocardial infarction, and ischemic stroke.
RESULTS: Among 601,011 statin initiators and 1,803,033 matched population cohort members during 2005-2015, the cumulative risk after 11 years was 2.8% for VTE (both cohorts), 4.7% vs. 2.9% for myocardial infarction, and 7.1% vs. 5.2 for ischemic stroke. After adjustment, statin use was associated with a slightly decreased risk of VTE (adjusted HR: 0.95 [95% CI: 0.92-0.97]), driven by a reduced risk of unprovoked VTE (adjusted HR: 0.92 [95% CI: 0.89-0.95]). The reduced risks of VTE were more pronounced among patients who had an imaging examination performed. The adjusted HRs were elevated for myocardial infarction and ischemic stroke.
CONCLUSIONS: Statin initiation was associated with a reduced risk of VTE, with no indication of a healthy-user effect. Based on available evidence, statins have weak thromboprophylactic effects.