Research in context
Evidence before this study
The lipid-lowering properties of statins and their effectiveness for the primary and secondary prevention of cardiovascular disease are well established. Statins are currently only approved for lipid lowering in the primary and secondary prevention of cardiovascular disease. We searched for relevant prospective cohort studies done in general populations and randomised controlled trials (RCTs) reporting on associations between statins and venous thromboembolism (including deep vein thrombosis and pulmonary embolism) in MEDLINE, Embase, Web of Science, and Cochrane Library, with particular emphasis on systematic reviews and meta-analyses. We used the search terms “statin”, “hydroxymethylglutaryl-CoA reductase inhibitors”, “venous thromboembolism”, “deep vein thrombosis”, and “pulmonary embolism”. Several observational studies were found to have investigated the relationship, but the results were conflicting. Some RCTs showed that statins reduced the occurrence of venous thromboembolism, but these results were based on few venous thromboembolism events, which suggested a statistical play of chance. Previous reviews on the topic have also reported inconsistent results. Statins might have a protective effect on the incidence of venous thromboembolism; however, the overall evidence is uncertain.
Added value of this study
This meta-analysis of observational and intervention studies suggests a beneficial effect of statin therapy on venous thromboembolism. In observational studies, the protective effect of statins on risk of venous thromboembolism remained consistent when grouped by various study-level characteristics. In intervention studies, rosuvastatin therapy substantially and significantly reduced the risk of venous thromboembolism risk, with no benefit seen with other statins.
Implications of all the available evidence
Based on both observational and clinical trial evidence, these findings underscore a potential beneficial role of statin therapy on venous thromboembolism in addition to its established role in cardiovascular disease prevention. The results also suggest that this effect of statins might be attributed to rosuvastatin. Prevention of venous thromboembolism could be another potential indication of statins; however, before any guideline recommendations can be made, further research is needed to unequivocally establish this potential true protective effect.