Statin treatment for primary and secondary prevention of pulmonary embolism: A population based case-control study

Background: Several studies suggested that statin treatment reduces the occurrence of venous thromboembolism (VTE). We analysed whether statins are not only beneficial for primary prevention, but also reduce the risk of recurrent pulmonary embolism (PE). Methods: A case-control study was conducted using data from the PHARMO Record Linkage System, a Dutch population-based registry of pharmacy records linked with hospital discharge records. Cases were patients hospitalized with a primary diagnosis of PE between 1998 and 2006. Four controls without a history of PE were matched to each case for age, gender and geographic region. The influence of statins on first and recurrent PE was assessed. Results: The study population consisted of 4.495 PE cases and 16.802 controls. The median age of the study population was 60 years (range 18-96) and 57% was female. Overall use of statins had no influence on PE (odds ratio (OR) 0.95; 95% confidence interval (CI) 0.84-1.07). Duration of statin use, type of VTE or cardiovascular history did not influence the outcome. In subanalysis for the type of statin, only Rosuvastatin reduced PE (OR 0.47; 95% CI 0.24-0.92). During a median follow-up period of 4.1 years (range 2.2-6.6), 396 (8.8%) patients had a recurrent PE. Interestingly, after adjustment for use of vitamin K antagonists, statin use reduced the occurrence of recurrent PE (HR 0.57; 95% CI 0.42-0.79). Conclusions: Statin treatment does not reduce the risk of a first episode of VTE but seems to be effective in the reduction of recurrent pulmonary embolism.