Statins protect against blood clots in people taking hormone therapy

Statin therapy appears to mitigate the risk of venous thromboembolism (VTE) associated with exogenous hormones, according to a study.

Data from a commercially insured claims database in the US showed that hormone therapy (HT) exposure raised the odds of VTE by 51 percent compared with nonexposure (odds ratio [OR], 1.51, 95 percent confidence interval [CI], 1.43–1.60), with the odds being greater for people taking HT without statins (OR, 1.53, 95 percent CI, 1.44–1.63) than for those taking HT with statins (OR, 1.25, 95 percent CI, 1.10–1.43). [JAMA Netw Open  2023;6:e2348213]

In a direct comparison between HT with statins and HT without statins, concomitant statin therapy appeared to be protective, being associated with 18-percent lower odds of VTE among people taking HT (OR, 0.82, 95 percent CI, 0.71–0.94). A notable dose-response effect was observed, such that high-intensity statins conferred greater protection against VTE than low-to-moderate–intensity statins (OR, 0.69, 95 percent CI, 0.50–0.95 and OR, 0.84, 95 percent CI, 0.73–0.98, respectively).

“In weighing the benefits of menopausal symptom relief against reported risks of VTE from clinical trials and cohort studies, this study provides insight into additional factors associated with the risk profile of HT users. Specifically, we found that the risk-benefit profile for HT may be more favourable when taking concomitant statin therapy,” the investigators said. [JAMA  2004;292:1573-1580; JAMA  2002;288:49-57; Cochrane Database Syst Rev 2017;1:CD004143; BMJ 2019;364:k4810]

The overall protection against VTE for people receiving HT and concomitant statin therapy was similar to that reported in previous studies, although the earlier data were hindered by limited statin use at the time, as the investigators pointed out. They also stressed that in the present study, statin therapy did not interact with HT but instead exerted independent VTE risk-lowering effects. [Menopause 2014;21:1023-1026; Circulation 2002;105:2962-2967]

Taken together, the evidence indicates that while women who are at higher cardiovascular risk may take statins and may therefore be labelled as unlikely candidates for HT, statin therapy appears to mitigate some of the risk from HT, according to the investigators.

“HT may not be contraindicated in women who are candidates for statin therapy,” they stated.

The study population comprised 223,949 women aged 50–64 years (mean 57.5 years), including 20,359 who had VTE and 203,590 matched non-VTE controls. A total of 19,558 women (8.73 percent) had recent HT exposure and 36,238 (16.18 percent) had current statin exposure. Compared with controls, women with VTE tended to have more comorbidities and risk factors for VTE.