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Vascular Surgery Patients on Statins Have Fewer Cardiac Complications

February 2, 2005

Boston, MA - In a retrospective study of patients undergoing non-cardiac vascular surgery, those who were taking statins were less likely to suffer heart-related complications, suggesting the cholesterol-lowering drugs might someday be given to patients before surgery, according to a new study published by Kristin O’Neil-Callahan, M.D., et. al., from the Cardiovascular Division and Department of Medicine at the Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachucetts, in the Feb. 1, 2005, issue of the Journal of the American College of Cardiology.

Cardiac complications of noncardiac surgery account represent a major source of perioperative mortality and morbidity, especially in patients with pre-existing coronary artery disease. Furthermore, with the exception of beta-blockers, no other pharmacologic therapies have been shown to significantly decrease the risk for perioperative complications. Statins have been shown to decrease cardiac events and increase survival in patients with coronary artery disease, supposedly by stabilizing atherosclerotic plaques and improving endothelial function. Based on this knowledge, the researchers in this study sought to evaluate the potential benefit of statin use in patients undergoing non-cardiac vascular surgery, with the primary endpoints of the study being cardiac complications (myocardial infarction, ischemia, congestive heart failure, ventricular tachyarrhythmias) and mortality.

The researchers reviewed the records of 1,163 patients who underwent vascular surgery at Beth Israel Deaconess Medical Center during 1999 and 2000. They recorded the number of deaths and heart-related complications, including heart attacks, heart failure and dangerous rapid heart rhythms, that occurred during or shortly after surgery. The procedures included carotid endarterectomy, aortic surgery or surgery to restore blood flow in the patients’ legs.

Complications occurred in 157 cases. Fifty-two (9.9 percent) patients who were taking statins suffered a complication, compared to 105 (16.5 percent) patients who were not taking statins. Even after adjusting the results to account for age, gender, type of surgery, indications of heart failure and diabetes, the odds ratio was 0.56 (95% confidence interval 0.39 to 0.79, p=0.0012), translating to a relative risk of a complication among patients who were taking statins that is about half of that for patients who were not taking statins. The researchers calculated that these results mean that one complication was prevented for every 15 patients taking statins.

The majority of the difference was a reduction in ischemia and heart failure. There was no statistically significant difference in the number of deaths or heart attacks.

While statins can offer a number of benefits to patients, including reducing the risk of artery blockages and inflammation, this study was not designed to reveal the mechanism by which statins might work to reduce surgical complications. The results of this retrospective observational study should be followed up with randomized controlled prospective trials, in order to determine whether statins are indeed responsible for the lower complication rates seen here.

Coauthors: George Katsimaglis, MD, Micah R. Tepper, MD, Jason Ryan, MD, Carla Mosby, MD, John P. A. Ioannidis, MD, Peter G. Danias, MD, Ph

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