CHEST: Statins May Cut Risk of Deep Vein Thrombosis in Cancer Patients

By John Gever
PHILADELPHIA, 09 nov 2008-- Statin treatment appeared to lower the rate of venous thromboembolism by two-thirds in cancer patients at risk for the condition, a researcher said here.About 8% of patients who had been taking statins for at least two months to control cholesterol before hospitalization with a solid-tumor later suffered venous thromboembolism, compared with 21% of those with short-term or no previous statin treatment (OR 0.33, 95% CI 0.19 to 0.59), reported Danai Khemasuwan, M.D., of Albert Einstein Medical Center here.The findings reflected adjustments for smoking status, metastatic disease, current use of chemotherapy, aspirin, and immobilization, he said at the American College of Chest Physicians meeting.Dr. Khemasuwan said the mechanism underlying the apparent effect remained unclear.
"It could be either the lipid-lowering effect … or it could be anti-inflammatory or anti-thrombolytic," he said, calling for a prospective, randomized trial to confirm the finding.
His study involved a review of 740 consecutive patients with a variety of solid tumors, prompted by suggestions in earlier studies that statins may reduce the DVT risk in other patient groups.
Most patients in the study had lung, breast, or prostate cancer. Other malignancies included tumors of the ovaries, stomach, colon, brain, kidney, esophagus, and pancreas.
Mean patient age was 65 and three-quarters were African-American. Patients were excluded if they had received anticoagulant therapies such as warfarin or heparin prior to admission.
About 31% of the sample had dyslipidemia at admission, and 26% were on statins.
He noted previous research indicating that statins decrease serum markers of inflammation, which in turn alters blood coagulation thresholds.
Patients in the study received simvastatin (Zocor), atorvastatin (Lipitor), or rosuvastatin (Crestor). The study did not attempt to determine whether one agent was more or less effective than the others in reducing venous thromboembolism risk, nor did it examine dosing.
A limitation of the study was that it did not measure serum lipids in patients. Differences between the statin-treated and control groups in lipid levels were a potential confounding factor.
Despite these limitations, David Gutterman, M.D., of the Medical College of Wisconsin in Milwaukee, said the findings were important.
"It's very logical," said Dr. Gutterman, who was not involved with the research. "I think it makes a lot of sense, particularly with regard to the pleiotropic effects of statins."
He said those effects "may not have so much to do with cholesterol, but may still have to do with inhibition of the HMG-co-reductase pathway," the main target of the statin class.
He noted that statins are well known to improve arterial endothelial function, which would be expected to have a favorable impact on thrombosis risk.
"The interesting thing about this study is that it suggests maybe the same kind of improvement is occurring on the venous side of the circulation," Dr. Gutterman said.
The study had no external funding. Dr. Khemasuwan and Dr. Gutterman reported no potential conflicts of interest.
Primary source: CHEST 2008Source reference:Khemasuwan D, et al "Statins decrease the incidence of venous thromboembolism: retrospective study in patients with solid organ tumor" CHEST 2008; 134: 8003S.Complete CHEST Coverage