Heart Health

05 May 2016

Statins before heart surgery may be ineffective

According to an Oxford professor of cardiovascular medicine, taking statins before cardiac surgery may not prevent postoperative complications.

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Taking cholesterol-lowering statins right before heart surgery, once touted as a way to prevent common postoperative complications, has no benefit and may even cause harm, a new study suggests.

Only for long-term treatment

In that setting, Crestor (rosuvastatin) did not prevent either the abnormal heart rhythm known as atrial fibrillation or heart damage, and it was linked to a slightly increased risk of kidney damage, researchers said.

"There are many valid reasons why one may want to take statins, but prevention of postoperative complications in cardiac surgery is not one of them," said lead researcher Dr Barbara Casadei. She is a professor of cardiovascular medicine at the University of Oxford in England.

Read: Should you be on statins?

"Our study is consistent with the idea that well-established beneficial effects of statin therapy, such as the reduction in heart attacks and strokes, are only achieved by long-term treatment with these drugs," she added.

For the study, Casadei and her colleagues randomly assigned more than 1,900 patients who were having elective heart surgery to take Crestor or a placebo before surgery.

The researchers found that patients given Crestor had lower levels of cholesterol and C-reactive protein (another marker for heart trouble) after surgery, compared with patients given a placebo.

Mild kidney damage

However, the percentages of those who developed atrial fibrillation were essentially the same in patients given Crestor (21.1 percent) and those given a placebo (20.5 percent), the investigators found.

Read: Statins protect after heart attack

And further analyses showed that Crestor was associated with a 5.4 percent greater chance of mild kidney damage, when compared with a placebo.

The cause of the kidney damage isn't known, said Casadei, since the study was not designed to show cause-and-effect. However, her team plans to study that issue further, she added.

"The risk of kidney injury is relatively small, but considering that the benefit of statin treatment before a heart operation is zero, one may well consider stopping statins for a few days before surgery," Casadei said.

The report was published in the New England Journal of Medicine.

Clouded findings

Dr Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said the study findings should not deter patients from taking statins to prevent heart attacks and strokes.

Read: International study sees statin advantages in lesser risk individuals

"Current guidelines recommend that all patients with cardiovascular disease, including patients after coronary artery bypass surgery, receive statins to lower the risk of fatal and nonfatal heart attacks and strokes," he said.

Beyond the intermediate and long-term benefits of statins, a number of small clinical trials have suggested an additional short-term benefit of starting or continuing statin therapy before heart surgery. However, many of these studies may have had problems that clouded the findings, Fonarow noted.

"This new trial suggests that there is no compelling reason to initiate statin therapy just before cardiac surgery," he said.

"However, long-term treatment with statins is essential to lower the intermediate and long-term risk of fatal and nonfatal cardiovascular events in patients with cardiovascular disease," Fonarow added.

Read more:

Atrial fibrillation

Heart attack

Atherosclerosis

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