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Concurrent use of statins and hormone therapy and risk of venous thromboembolism in postmenopausal women: a population-based case-control study

Fournier, Jean-Pascal MD, PhD1; Duijnhoven, Ruben G. MSc1,2; Renoux, Christel MD, PhD1,3; Dell’Aniello, Sophie MSc1; Klungel, Olaf H. PharmD, PhD1,2; Suissa, Samy PhD1

doi: 10.1097/GME.0000000000000279
Brief Report

Objective: Statins and hormone therapy (HT), often used concurrently in postmenopausal women, have antagonist effects on the risk of venous thromboembolism (VTE). This study aims to determine whether statins attenuate the increased VTE risk associated with HT.

Methods: We conducted a nested case-control study within a population-based cohort of women aged 50 to 79 years between January 1, 1987 and March 1, 2008, who were identified from the UK General Practice Research Database. Cases of VTE occurring during follow-up were identified and each matched with up to 10 controls from the cohort. Odds ratios (ORs) for the effects of concurrent HT and statin use on the risk of VTE were estimated using conditional logistic regression with interaction terms.

Results: The cohort included 955,582 postmenopausal women, with 23,505 cases of VTE matched with 231,562 controls. Regardless of any HT use, current use of statins was associated with a decreased risk of VTE (OR, 0.83; 95% CI, 0.78-0.87). The interaction between statin use and HT use was of borderline significance (P = 0.053). Consequently, among nonusers of statins, the risk of VTE was elevated with current use of oral estrogen and progestogen combinations (OR, 1.55; 95% CI, 1.45-1.66) but this risk was not elevated among users of statins (OR, 0.98; 95% CI, 0.56-1.73). There was no such modification of the OR with statins and other HT types and formulations.

Conclusions: Statins could potentially attenuate the increased risk associated with HT combinations of oral estrogens and progestogens. This observation needs further confirmation in other large cohorts.

From the 1McGill Pharmacoepidemiology Research Unit, Departments of Epidemiology and Biostatistics and Medicine, Jewish General Hospital, McGill University, Montreal, QC, Canada; 2Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; and 3Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.

Received March 11, 2014; revised and accepted April 16, 2014.

Funding/support: This study was funded by the Canadian Institutes of Health Research.

Financial disclosure/conflicts of interest: S.S. received research funding from Organon, Schering, and Wyeth, makers of hormone therapy. All other authors declare no conflicts of interest.

Address correspondence to: Samy Suissa, PhD, Center for Clinical Epidemiology, Jewish General Hospital, 3755 côte Sainte-Catherine, Montreal, QC, Canada H3T 1E2. E-mail: samy.suissa@mcgill.ca

© 2014 by The North American Menopause Society.