Benefits of Perioperative Statins Confirmed


Major Finding: Perioperative statin use was associated with a significant reduction of perioperative cardiovascular events (HR, 0.55) and improved long-term outcome (HR, 0.59).

Data Source: A further analysis of 497 patients in the randomized, double-blind, DECREASE III trial.

Disclosures: Dr. Schouten stated that he had nothing to disclose.

CHICAGO – Results from a follow-up analysis of patients in the randomized, double-blind DECREASE III trial showed that there is an apparent “legacy” effect of perioperative statin therapy, resulting in improved long-term survival, compared with statin initiation after a patient undergoes vascular surgery.

Ischemic cardiac events are a major cause of perioperative morbidity and mortality in noncardiac surgery, with an estimated 10%–40% of perioperative deaths ascribed to myocardial infarction, according to the original report by Dr. Don Poldermans and the DECREASE (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography) III researchers. Results of the original DECREASE III study showed that in high-risk patients who undergo major vascular surgery, fluvastatin XL reduced myocardial ischemia and the combined end point of cardiovascular death and MI.

Dr. Olaf Schouten from the Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues further analyzed of the DECREASE III population, examining 497 patients who were randomized to placebo (247 patients) or fluvastatin (250) in the double-blinded trial.

The patients had been started on treatment a median of 34 days prior to surgery. At the end of the DECREASE III study period (30 days after surgery), all patients were prescribed lifelong statins as recommended by current guidelines. The current study relied on all-cause death data obtained from a civil service registry for a median follow-up of 4.8 years, during which time 129 patients died.

Perioperative statin use was linked with a significant reduction of perioperative cardiovascular events (hazard ratio, 0.55), Dr. Schouten said at the meeting. In a multivariate analysis that adjusted for possible confounders including cardiovascular risk factors, type and site of vascular surgery, and age, preoperative statin initiation was still significantly associated with an improved long-term outcome (HR, 0.59).

“This 'legacy' effect might be due to the prevention of perioperative myocardial damage, as patients with myocardial damage had a significantly higher risk of death during follow-up,” Dr. Schouten said.

“The main message of our study is that all vascular surgery patients eligible for statin therapy [with no contraindications] should be prescribed statins at the first, preoperative, and outpatient clinic visit,” said Dr. Schouten in an interview. He pointed out that statin therapy is safe in the perioperative period, with no significant side effects; it improves perioperative cardiac outcome; and it is associated with a long-term survival benefit.

Patients eligible for statin therapy should get statins at the first, preoperative, and outpatient clinic visit.

Source Dr. schouten

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