Do statins protect against upper gastrointestinal bleeding?

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT center dot An apparent protective effect of statins against upper gastrointestinal bleeding was postulated in a post hoc analysis of a randomized trial. center dot We aimed to evaluate the effect of statin use on acute nonvariceal upper gastrointestinal bleeding alone or in combinations with low-dose aspirin and other antithrombotic drugs. WHAT THIS STUDY ADDS center dot Our study could not demonstrate an inverse association between use of statins and upper gastrointestinal bleeding. center dot The lack of effect was consistent across most subgroups, across different cumulative or current doses and different statin substances. center dot In explorative analyses, there appeared to be protective effect only in users of low-dose aspirin. center dot There was no interaction with use of other antithrombotic drugs. Recently, an apparent protective effect of statins against upper gastrointestinal bleeding (UGB) was postulated in a post hoc analysis of a randomized trial. We aimed to evaluate the effect of statin use on acute nonvariceal UGB alone or in combinations with low-dose aspirin and other antithrombotic drugs. A population-based case-control study was conducted in the County of Funen, Denmark. Cases (n = 3652) were all subjects with a first discharge diagnosis of serious UGB from a hospital during the period 1995 to 2006. Age- and gender-matched controls (10 for each case) (n = 36 502) were selected by a risk set sampling. Data on all subjects' drug exposure and past medical history were retrieved from a prescription database and from the County's patient register. Confounders were controlled by conditional logistic regression. The adjusted odds ratios (ORs) associating use of statins with UGB were 0.94 (0.78-1.12) for current use, 1.40 (0.89-2.20) for recent use and 1.42 (0.96-2.10) for past use. The lack of effect was consistent across most patient subgroups, different cumulative or current statin doses and different statin substances. In explorative analyses, a borderline significant protective effect was observed for concurrent users of low-dose aspirin [OR 0.43 (0.18-1.05)]. Statins do not prevent UGB, except possibly in users of low-dose aspirin.