Page last updated at 09:10 GMT, Monday, 30 March 2009 10:10 UK
Statin cuts risk of blood clots
A cholesterol-lowering statin drug can significantly cut the risk of potentially fatal blood clots, US research suggests.
In trials rosuvastatin cut the risk of venous thromboembolism (VTE) in healthy people by 43%.
Forms of VTE include deep vein thrombosis (DVT) and pulmonary embolism, the most common cause of preventable death in hospital patients.
The study appears in the New England Journal of Medicine.
Deep vein thrombosis: An early form of VTE in which blood clots develop in the legs or pelvis
Pulmonary embolism: Part of a clot breaks off and lodges in the arteries that supply the lungs.
People who face prolonged periods of immobility at increased risk
More than 25,000 people a year die in Britain after developing fatal blood clots.
It is estimated that 52% of hospital patients in the UK are at risk of developing DVT.
However, the MPs' report published in November 2007 said that less than half are made aware of the risks, and only a third will be risk assessed by a healthcare professional.
DVT has also been associated with long-haul air travel, where passengers have limited opportunity to move around.
The latest, long-term study, presented at an American College of Cardiology conference, was based on 17,802 healthy men and women.
Statins have already been shown to reduce the risk of heart attack and stroke.
Rosuvastatin, manufactured by AstraZeneca and marketed as Crestor, is just one type of the drug. Other brands were not tested in the current trial.
Lead researcher Dr Paul Ridker, of Brigham and Women's Hospital, said: "The clinical bottom line here is simple, in addition to reducing risks of heart attack and stroke, we now have hard evidence that aggressive statin therapy reduces life-threatening blood clots in the veins."
Dr Ridker added that statin therapy carried no risk of excess bleeding - a side effect associated with alternative blood-thinning treatments such as warfarin.
Professor Peter Weissberg, medical director of the British Heart Foundation, welcomed the study.
He said: "Further clinical trials are now needed to see if patients at high risk of a DVT are protected by statins.
"If they are, the findings could lead to such patients being prescribed statins to protect them in the future."
Published at www.nejm.org March 29, 2009 (10.1056/NEJMoa0900241)
A Randomized Trial of Rosuvastatin in the Prevention of Venous Thromboembolism
Robert J. Glynn, Sc.D., Eleanor Danielson, M.I.A., Francisco A.H. Fonseca, M.D., Jacques Genest, M.D., Antonio M. Gotto, Jr., M.D., John J.P. Kastelein, M.D., Wolfgang Koenig, M.D., Peter Libby, M.D., Alberto J. Lorenzatti, M.D., Jean G. MacFadyen, B.A., B?rge G. Nordestgaard, M.D., James Shepherd, M.D., James T. Willerson, M.D., and Paul M Ridker, M.D.
Background Controversy persists regarding the extent of shared pathways between arterial and venous thrombosis and whether treatments of known efficacy for one disease process have consistent benefits for the other. Observational studies have yielded variable estimates of the effect of statin therapy on the risk of venous thromboembolism, and evidence from randomized trials is lacking.
Methods We randomly assigned 17,802 apparently healthy men and women with both low-density lipoprotein (LDL) cholesterol levels of less than 130 mg per deciliter (3.4 mmol per liter) and high-sensitivity C-reactive protein levels of 2.0 mg per liter or higher to receive rosuvastatin, 20 mg per day, or placebo. We followed participants for the first occurrence of pulmonary embolism or deep-vein thrombosis and performed analyses of the data on an intention-to-treat basis.
Results During a median follow-up period of 1.9 years (maximum, 5.0), symptomatic venous thromboembolism occurred in 94 participants: 34 in the rosuvastatin group and 60 in the placebo group. The rates of venous thromboembolism were 0.18 and 0.32 event per 100 person-years of follow-up in the rosuvastatin and placebo groups, respectively (hazard ratio with rosuvastatin, 0.57; 95% confidence interval [CI], 0.37 to 0.86; P=0.007); the corresponding rates for unprovoked venous thromboembolism (i.e., occurring in the absence of a known malignant condition, trauma, hospitalization, or surgery) were 0.10 and 0.17 (hazard ratio, 0.61; 95% CI, 0.35 to 1.09; P=0.09) and for provoked venous thromboembolism (i.e., occurring in patients with cancer or during or shortly after trauma, hospitalization, or surgery), 0.08 and 0.16 (hazard ratio, 0.52; 95% CI, 0.28 to 0.96; P=0.03). The rates of pulmonary embolism were 0.09 in the rosuvastatin group and 0.12 in the placebo group (hazard ratio, 0.77; 95% CI, 0.41 to 1.45; P=0.42), whereas the rates of deep-vein thrombosis only were 0.09 and 0.20, respectively (hazard ratio, 0.45; 95% CI, 0.25 to 0.79; P=0.004). Consistent effects were observed in all the subgroups examined. No significant differences were seen between treatment groups in the rates of bleeding episodes.
Conclusions In this trial of apparently healthy persons, rosuvastatin significantly reduced the occurrence of symptomatic venous thromboembolism. (ClinicalTrials.gov number, NCT00239681 [ClinicalTrials.gov] .)
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