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, PhD
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