Statins and Venous Thromboembolic Disease - Where are we Now?

IF 2.8 3区医学 Q2 PERIPHERAL VASCULAR DISEASE Current vascular pharmacology Pub Date : 2024-01-01 DOI:10.2174/0115701611308323240229050237

Pavel Poredoš, Debabrata Mukherjee, Aleš Blinc

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Abstract

Classical risk factors for atherosclerosis also play a role in the pathogenesis of venous thromboembolism (VTE). Low-density lipoprotein cholesterol has prothrombotic and endothelium- deteriorating effects which are not limited to the arterial system. The association between hypercholesterolemia and VTE has been established, but the benefits of statins in the prevention of VTE assessed by observation studies seemed equivocal. The large, randomized trial Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) recorded the occurrence of VTE as a protocol-specified endpoint and reported a reduced incidence of VTE among subjects taking 20 mg of rosuvastatin daily vs placebo (hazard ratio 0.57; 95% confidence interval 0.37-0.86; p=0.007). Similar results were confirmed by meta-analyses of observation studies and randomized trials. Recently, a Mendelian randomization study that took the presence of gene variants coding for less efficient hydroxymethyl-glutaryl coenzyme A reductase activity as a proxy for statin treatment, confirmed a small, but significant negative association between the score of selected genetic polymorphisms and the incidence of VTE. However, since the protective effects of statins are limited, they should not be substituted for guideline-recommended VTE prophylaxis or anticoagulation treatment.

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他汀类药物与静脉血栓栓塞性疾病--我们现在在哪里？

动脉粥样硬化的传统风险因素在静脉血栓栓塞症（VTE）的发病机制中也发挥着作用。低密度脂蛋白胆固醇具有促血栓形成和内皮恶化的作用，这种作用并不局限于动脉系统。高胆固醇血症与 VTE 之间的关系已经确定，但观察研究评估他汀类药物在预防 VTE 方面的益处似乎并不明确。大型随机试验 "在预防中使用他汀类药物的理由：评价瑞舒伐他汀的干预试验"（JUPITER）将 VTE 的发生率作为方案指定的终点，并报告称每日服用 20 毫克瑞舒伐他汀的受试者与安慰剂相比，VTE 的发生率有所降低（危险比为 0.57；95% 置信区间为 0.37-0.86；P=0.007）。观察研究和随机试验的荟萃分析也证实了类似的结果。最近，一项孟德尔随机化研究以编码羟甲基-戊二酰辅酶 A 还原酶活性较低的基因变异作为他汀类药物治疗的代表，证实了所选基因多态性得分与 VTE 发生率之间存在微小但显著的负相关。然而，由于他汀类药物的保护作用有限，因此不应将其取代指南推荐的 VTE 预防或抗凝治疗。

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来源期刊

Current vascular pharmacology 医学-外周血管病

CiteScore

9.20

自引率

4.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Vascular Pharmacology publishes clinical and research-based reviews/mini-reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research. Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).