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Statin use confers better outcomes after cardiac arrest, particularly in patients with diabetes
NEW ORLEANS — Among patients with out-of-hospital cardiac arrest, those taking statins had better survival outcomes compared with those who did not take statins, according to the results of a retrospective cohort study presented at the American Heart Association Scientific Sessions.
The effect was especially apparent in individuals with diabetes, researchers reported.
Ping-Hsun Yu, MD, a researcher from the Taipei Ministry of Health and Welfare, New Taipei City, Taiwan, and colleagues hypothesized that statin use before cardiac arrest might improve outcomes because the pleiotropic effects of statins include attenuation of inflammation-related damage and endothelial dysfunction.
Using a health insurance research database, the researchers identified 137,933 patients aged 18 years and older who had out-of-hospital cardiac arrest not related to trauma and for whom resuscitation was attempted in the ED in Taiwan between 2004 and 2011.
The researchers identified 9,059 patients in the cohort who had used statins for at least 90 days within the year before cardiac arrest. Using propensity matching, they compared 8,249 patients who took statins with 24,747 who did not take statins.
The outcomes of interest were survival to admission, survival to discharge and survival to 1 year.
Yu and colleagues found that, compared with no statin therapy, those taking statins were more likely to survive to admission (OR = 1.19; 95% CI, 1.12-1.27), to survive to discharge (OR = 1.47; 95% CI, 1.31-1.65) and to 1 year (OR = 1.5; 95% CI, 1.31-1.71).
When the researchers constructed a logistic regression model, they determined statin use was an independent predictor of 1-year survival after cardiac arrest (OR = 1.45; 95% CI, 1.26-1.68).
According to results of a subgroup analysis, the effect of statin use on survival after cardiac arrest was especially significant in patients with diabetes.
Limitations include that more than 95% of patients were Asian and that type of statin and intensity of statin dose were not recorded, according to a press release.
“There is some risk associated with statins, but this study confirms the benefit,” Yu said in the release. “[A future study could] divide the statins into different subgroups to see if different potencies or types result in different outcomes. – by Erik Swain
Reference:
Yu PH, et al. Presentation 15. Presented at: American Heart Association Scientific Sessions; Nov. 12-16, 2016; New Orleans.
Disclosure: Yu reports no relevant financial disclosures.
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This is an interesting abstract adding to the many studies documenting potential benefits from statins. These drugs reduce lipids, but also seem to have important anti-inflammatory properties, allowing them to improve health in many different cardiac and vascular diseases.
This is a retrospective study showing that patients who were taking statins recently had higher odds of surviving a cardiac arrest. The authors had a large dataset from Taiwan, allowing them to adjust and account for a lot of variables in order to isolate the effect of statins alone.
Note that cardiac arrest is more than MI and is much more lethal. Many cardiac arrests result from a MI, but only a small percentage of MIs lead to cardiac arrest. Statins reduce risk for MI and improve recovery from MI, but their impact on cardiac arrest has not been studied very much.
All retrospective studies are limited by a potential bias because the patients who were taking the drugs in the first place may differ from patients who were not taking the drugs. For example, the patients who were taking statins might have had better overall medical care or might have been more likely to have treatable CVD, which is associated with better outcomes from cardiac arrest.
This paper supports the wide use of statins as is common in many places already. It would require prospective clinical trials to see if we can give statins to patients after a cardiac arrest in order to improve their recovery.