Statin Use And The Risk Of Venous Thromboembolism In Women Taking Hormone Therapy

Abstract

ABSTRACTImportanceWhile hormone therapy (HT) in perimenopausal women can increase risk for venous thromboembolism (VTE), it is unclear to what extent statins may reduce HT-related risk.ObjectiveTo estimate VTE risk in 50–64-year-old women taking HT with or without statins and by statin intensity.DesignA nested case-control study.SettingA US, commercially insured claims database.ParticipantsWomen aged 50-64 with at least one year of continuous membership between 2008-2019.ExposureFilled prescriptions for estrogens, progestogens, and statins were recorded in 12 months prior to index. Recent HT was defined as any estrogen or progestogen exposure within 60 days before the index date. Current statin exposure was defined as 90 or more days of continuous exposure prior to and including the index date. Statin intensity was defined by the statin exposure 30 days prior to index.Main Outcomes and MeasuresCases were identified with VTE diagnoses (ICD codes) preceded by at least 12 months without VTE and followed within 30 days by anticoagulation, an inferior vena cava filter placement, or death. Controls were matched to cases (10:1) on date and age. Conditional logistic regression models estimated risk for HT and statin exposures with odds ratios (OR), adjusted for comorbidities.ResultsThe total sample (mean age 57.5) included 20,359 cases and 203,590 matched controls; 9% had recent HT exposure and 16% had current statin exposure. In adjusted models, the OR for any recent HT exposure was 1.51 (95%CI:1.43-1.60) compared to no recent HT exposure. The OR for current statin therapy was 0.88 (95%CI:0.84-0.93) compared to no current statin exposure. The OR was 1.53 (95%CI:1.44-1.63) for those with HT without statins, 1.25 (95%CI:1.10-1.43) with HT with statins, and 0.89 (95%CI:0.85-0.94) with statins without HT compared to no recent HT and no current statins. HT with statin therapy had a 18% significantly lower OR than HT without statins (OR=0.82,95%CI:0.71-0.94) and greater risk reduction with higher intensity statins.Conclusions and RelevanceIn this case-control study, statin therapy was associated with reduced risk of VTE in women taking HT with greater risk reduction with high-intensity statins.Key PointsQuestionWhat is the impact of statin therapy in perimenopausal women exposed to hormone therapy?FindingsIn this case-control study of approximately 225,000 women aged 50-64, the VTE odds ratio was 53% higher in women recently exposed to HT without current statin therapy and 25% higher with recent HT exposure and current statin therapy compared to women without recent HT and current statin exposures,MeaningThese findings suggest statins may reduce risk of VTE in women exposed to HT and further, HT may not be contraindicated in women taking statins.