Statins before surgery cut deaths

A dose of a cholesterol-lowering statin before vascular surgery reduces the risk of complications and death, new Dutch research shows.

The study of nearly 500 patients who had surgery for a variety of blood-vessel problems found the incidence of heart artery blockage and deaths was halved in those who received an 80-milligram dose of fluvastatin (sold as Lescol in South Africa) before their operation, compared to those given a placebo.

"The manuscript showed that fluvastatin extended-release is safe in the perioperative period, associated with a reduced inflammatory status and improved outcome, compared to placebo," said Dr Don Poldermans, a professor of internal medicine at Erasmus Medical Center in Rotterdam, the Netherlands, and a principal author of a report in the Sept. 3 issue of the New England Journal of Medicine.

Heart artery blockage occurred in 10.8 percent of the people who received fluvastatin and 19 percent of those who were given a placebo, the report said. Deaths from heart attacks or other cardiovascular problems occurred in 4.8 percent of those who received fluvastatin and 10.1 percent of those given placebo.

Lower incidence of stroke
The new study confirms the growing idea that statin therapy is a valuable tool in blood-vessel surgery, American experts said.

"This study confirms a lot of previous work," said Dr Bruce Perler, chief of vascular surgery at Johns Hopkins Medical Institutions, in Baltimore. "Much of that work comes from small, retrospective studies. This is a well-done, placebo-controlled trial that confirms what we have suspected for a long time."

Perler led one previous study that compared the outcome of surgery on the carotid artery, the main artery to the brain, in people who had or had not been taking a statin before the operation. "We showed in our study a significantly lower incidence of 30-day stroke and 30-day deaths [with statin treatment]," Perler said.

That study did not distinguish between the various statins being used, but "there is no reason to believe that this isn't a class effect," said Dr Louis Teichholz, medical director of the division of cardiology at Hackensack University Medical Center, in New Jersey. "No matter which statin you give, there is no major difference over another statin."

Reduced inflammation could be key
The major reason for the benefit in surgery probably is not the cholesterol-lowering effects of statins, Perler and Teichholz noted, because the benefit was seen in people who did not have high cholesterol.

The drugs also reduce inflammation, and the Dutch study found marked reductions in markers of inflammation in those given a statin, Teichholz said.

"Statins also have major anti-thrombotic [clot-preventing] effects and are antioxidants," Perler said.

There are no current guidelines recommending use of statins before vascular surgery, but the concept seems to be taking hold in clinical practice, Teichholz noted. "It appears to be what we should be doing, barring contraindications," he said. "There are no official guidelines but, based on this and other studies, it would be prudent to consider statins in patients with vascular disease."

Statins can cause acute muscle pain in a minority of people, and they can be dangerous in people with poor liver function, but are otherwise safe, Teichholz said.

One practical reason why physicians might not prescribe a statin before vascular surgery is that so many people already are taking them, Perler said. "In my practice, it is very unusual to see patients who are not on statins," he added.

(HealthDay News, September 2009)