Lipid lowering therapy in venous thromboembolism. A Clinical Consensus Statement of the ESC Working Group on Aorta and Peripheral Vascular Diseases. 

<h2 id="Aim">Aim</h2><ul><li>To summarize the current evidence on the role of lipid-lowering therapy (LLT) in the primary and secondary prevention of venous thromboembolism (VTE).</li><li>To explore the potential relationship between lipids, lipid-lowering agents, and VTE risk.</li><li>To evaluate possible antithrombotic and anti-inflammatory mechanisms of lipid-lowering therapy beyond LDL-C reduction.</li><li>To provide clinical consensus statements on the potential role of lipid-lowering therapy in patients with or at risk of VTE.</li></ul><h2 id="Method">Method</h2><ul><li>Clinical consensus statement developed by ESC Working Groups on aorta and Peripheral Vascular Diseases; cardiovascular Pharmacotherapy; pulmonary Circulation &amp; Right Ventricular Function in collaboration with the European Society of Vascular Medicine (ESVM).</li><li>Existing evidence from randomized controlled trials (RCTs), post-hoc analyses, observational studies, registries, systematic reviews and meta-analyses was reviewed.</li><li>Evidence was assessed across relationship between serum lipids and VTE; role of lipid-lowering therapy for primary and secondary prevention/recurrent VTE with potential mechanisms underlying the effects of lipid-lowering therapy.</li><li>Therapies evaluated included statins, PCSK9 inhibitors, bempedoic acid, ezetimibe and fibrates.</li></ul><h2 id="Results">Results</h2><h3 id="1-common-cardiovascular-risk-profile-in-vte-and-ascvd">1. Common Cardiovascular Risk Profile in VTE and ASCVD</h3><ul><li>VTE includes deep-vein thrombosis (DVT) and pulmonary embolism (PE).</li><li>VTE and ASCVD share several risk factors, including advanced age; obesity; smoking; hypertension; diabetes mellitus; dyslipidemia and metabolic syndrome.</li><li>Patients with VTE have an increased risk of subsequent arterial cardiovascular events, supporting overlap between venous and arterial thrombotic disease.</li></ul><h3 id="2-relationship-between-lipids-and-vte-remains-heterogeneous">2. Relationship Between Lipids and VTE Remains Heterogeneous</h3><ul><li>Available evidence shows no clear association of total cholesterol or LDL-C with VTE occurrence.</li><li>Higher triglyceride levels may be associated with VTE, whereas higher HDL-C appears inversely associated.</li><li>Higher concentrations of polyunsaturated n-3 fatty acids have been associated with a lower risk of VTE.</li></ul><h3 id="3-lipid-lowering-therapy-reduces-the-risk-of-a-first-vte-event">3. Lipid-Lowering Therapy Reduces the Risk of a First VTE Event</h3><ul><li>In the JUPITER trial involving 17,802 participants, rosuvastatin 20 mg reduced symptomatic VTE compared to placebo (0.38% vs 0.67%; HR 0.57; p=0.007).</li><li>A meta-analysis incorporating JUPITER and HOPE-3 reported a 47% reduction in VTE risk with rosuvastatin. PCSK9 inhibitor RCT data showed lower VTE risk versus placebo when added to statins (HR 0.69).</li><li>A network meta-analysis showed the largest VTE risk reduction with PCSK9 inhibitor + high-intensity statin (RR 0.59).</li><li>Bempedoic acid was also associated with reduced VTE risk in the CLEAR Outcomes analysis. In contrast, fibrates were associated with increased VTE risk (OR 1.58).</li></ul><h3 id="4-statins-reduce-recurrent-vte">4. Statins Reduce Recurrent VTE</h3><ul><li>A cohort of 2,798 patients with incident VTE reported a 26% lower risk of recurrent VTE among statin users.</li><li>A meta-analysis of 1,93,576 patients with previous VTE found 27% lower recurrent VTE risk (RR 0.73).</li><li>In COMMAND VTE Registry-2, 5-year recurrent VTE was 6.8% with statins vs 10.1% without statins (Adjusted HR 0.65).</li><li><strong>An updated meta-analysis of 12 observational studies similarly showed lower recurrence:</strong><ul><li>Overall VTE: HR 0.76</li><li>Recurrent DVT: HR 0.71</li><li>Recurrent PE: HR 0.80</li></ul></li></ul><h3 id="5-potential-benefits-may-extend-beyond-ldl-c-lowering">5. Potential Benefits May Extend Beyond LDL-C Lowering</h3><ul><li>The association between lipid-lowering therapy and reduced VTE may involve pleiotropic antithrombotic and anti-inflammatory effects rather than LDL-C reduction alone.</li><li><strong>In the START trial, rosuvastatin reduced:</strong><ul><li>Factor VIII</li><li>Thrombin-generation potential</li><li>Plasma procoagulant phospholipid activity</li><li>While increasing fibrinolytic potential</li></ul></li><li>Other proposed mechanisms include effects on inflammation, platelet activity, coagulation pathways and potentially Lp(a).</li></ul><h2 id="Conclusions" data-section="conclusion">Conclusions</h2><ul><li>ASCVD and VTE are interconnected, sharing several cardiovascular risk factors; therefore, patients presenting with VTE should undergo ASCVD risk-factor assessment.</li><li>In patients with ASCVD, lipid-lowering therapy prescribed for cardiovascular risk reduction may additionally reduce the risk of a first VTE event.</li><li>In patients without ASCVD, current evidence does not support initiating lipid-lowering therapy solely for primary VTE prevention.</li><li>In patients with previous VTE, lipid-lowering therapy—particularly statin therapy—has been associated with lower VTE recurrence.</li><li>Lipid-lowering therapy should therefore be initiated when appropriate based on the patient's ASCVD risk and established lipid-management indications.</li></ul><p><i><strong>Disclaimer: </strong>This scientific information content is facilitated by Mega Lifesciences and is intended for healthcare professionals for their reading and update. Although care has been taken in compiling and checking the information, the facilitator is not responsible, or in any way liable for any errors, omissions or inaccuracies in this content whether arising from negligence or otherwise, however, or for any consequences arising therefrom.</i></p>

2447552bcbf7 Cardiology Update   Issue 5   Sept 2026   Final

<ol dir="ltr"><li><a href="#Aim">Aim</a></li><li><a href="#Method">Method</a></li><li><a href="#Results">Results</a></li><li><p><a href="#Conclusions">Conclusions</a></p><p>&nbsp;</p></li></ol>

Lipid lowering therapy in venous thromboembolism. A Clinical Consensus Statement of the ESC Working Group on Aorta and Peripheral Vascular Diseases.

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