Cardiovasc Res. 2021 Mar 10:cvab078. doi: 10.1093/cvr/cvab078. Online ahead of print.
AIMS: To examine the association between rosuvastatin and VTE risk, and whether effects vary in different subpopulations stratified by key demographic, cardiovascular disease (CVD) risk factors and other risk factors associated with VTE.
METHODS AND RESULTS: An individual participant data meta-analysis was conducted across two randomized controlled trials in 30,507 participants over a mean follow up of 3.62 years, Individuals had no prior history of vascular disease but were at intermediate CV risk. In both trials, participants were randomized to receive rosuvastatin or matching placebo. The primary outcome was VTE during follow-up, defined as either deep vein thrombosis or pulmonary embolism. Associations between rosuvastatin and VTE were examined in the overall pooled cohort, and subpopulations stratified by demographic risk factors (i.e. age, sex), CVD risk factors (i.e. obesity, smoking, lipid levels, blood pressure levels, C-reactive protein level), and a history of cancer.Mean age was 65.96 (SD 7.19) years of age, and 17,832 (58.45%) were male. 5,434 (17.82%) were smokers, median BMI was 27.6 (Interquartile range [IQR] 24.7 - 31.1) kg/m2, and median CRP level was 3.4 (IQR 2.1 - 6.0) mg/L. There were 139 VTE events. In the pooled cohort, rosuvastatin was associated with a large proportional reduction in the risk of VTE (hazard ratio 0.53, 95% CI 0.37 - 0.75). No significant interactions were observed between treatment with rosuvastatin and the risk of VTE across subpopulations stratified by demographic, CVD risk factors or a history of cancer (p-values for interactions >0.05 for all subgroups).
CONCLUSIONS: Rosuvastatin is associated with a 47% proportional reduction in the risk of VTE, and its effect is consistent both in the presence or absence of VTE related clinical risk factors.
TRANSLATIONAL PERSPECTIVE: In this individual participant data meta-analysis of two large randomized controlled trials comparing rosuvastatin to placebo, rosuvastatin was associated with a 47% proportional reduction in the risk of VTE. The effect of rosuvastatin was consistent across a broad range of demographic factors, cardiovascular risk factors, and a history of cancer. This study demonstrates that rosuvastatin is broadly affective at reducing the risk of VTE both in the presence or absence of VTE associated clinical risk factors. Results inform future research on the use of statins for this indication.