Statins seem to have beneficial perioperative effects

Benefit could be due to an antithrombotic effect, but exact mechanism is unclear.

Patients undergoing noncardiac vascular surgery were less likely to experience perioperative complications while on statin treatment, according to the results of a retrospective study.

“Although these data do not suffice to recommend the broad use of statins to decrease cardiac risk in noncardiac surgery, our data create the impetus for a prospective evaluation,” Peter G. Danias, MD, PhD, a cardiologist at Hygeia Hospital in Greece and assistant professor of Medicine at Tufts Medical School, told Cardiology Today.

Danias was the corresponding author on the Statins for Risk Reduction in Surgery (STARRS) Study, a retrospective records analysis of patients undergoing carotid endarterectomy, aortic surgery or lower extremity revascularization. Results were published in a recent Journal of the American College of Cardiology.

Researchers identified 1,163 hospitalizations from a tertiary referral center during a two-year period from January 1999 to December 2000. They identified 157 complications including death, MI, ischemia, congestive heart failure and ventricular tachyarrhythmia.

Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect, according to the research abstract.

Perioperative complications

Of the original cohort, 45.2% of patients were taking statins. These patients had a significantly (P=.001) lower rate of perioperative complications at 9.1% compared to 16.5% among those patients not taking statins.

Statin use retained its protective effect (OR=.52, P=.001) after adjustment for age, gender, type of surgery, emergent surgery, left ventricular function and diabetes mellitus. The protective effect was similar across all patient subgroups.

The benefit of statin use was primarily shown by the rates of congestive heart failure, with 21 events in the statin group and 50 events in the control group, and “other ischemia” with five events in the statin group compared to 26 in the control group.

Danias said the mechanism of benefit for statin use during surgery is uncertain, and the study was not designed to ask the question. However, he offered several speculations.

“Statins may have antithrombotic effects unrelated to cholesterol reduction and antiinflammatory effects through the down regulation of cytokines. Statins may also influence the vascular subcellular milieu to shift vasoactive factors towards vasodilatation,” Danias said. “In previous studies of experimental models of MI and HF, statins normalized the sympathetic outflow and reflex regulation, and attenuated left ventricular remodeling. Other reports involving humans with dilated cardiomyopathy have suggested that short-term use of statins is associated with the improvement of cardiac function and symptoms.”

James S. Forrester, MD, Cedars-Sinai Medical Center and the UCLA School of Medicine, agreed that inflammation could play a role in the protective effects of statins.

“In the past few years, a substantial body of data have emerged suggesting that statins have a beneficial effect on vascular function through their antiinflammatory action, independent of their effect on serum cholesterol.

“Because local inflammation is an unavoidable consequence of vascular surgery, I believe that this report should lead to a larger trial testing statin therapy in these procedures,” Forrester said in a written statement. – by Jeremy Moore

For more information:

• O’Neil-Callahan K, Katsimaglis G, Tepper MR, et al. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: The Statins for Risk Reduction in Surgery (STARRS) Study. J Am Coll Cardiol. 2005;45:336-42.