Stopping statin prior to surgery

Continuation of statin therapy if patients undergoing vascular surgery

• there is evidence that if patients are currently taking statins and scheduled for vascular surgery, then statins should be continued
  • Hindler et al. conducted a meta-analysis to evaluate the overall effect of preoperative statin therapy on postoperative outcomes
    • preoperativestatin therapy was associated with 59% reduction in the risk of mortality after vascular (1.7% versus 6.1%; p=0.0001) surgery. When including noncardiac surgery, a 44% reduction in mortality (2.2% versus 3.2%; p=0.0001) was observed
  • a randomized controlled trial has been performed to evaluate the effectiveness of statin therapy for perioperative cardiovascular risk protection
    • Durazzo et al. randomized 100 patients who were to undergo vascular surgery to atorvastatin 20 mg per day or placebo
      • subjects in the study received atorvastatin for an average of 30 days before undergoing vascular surgery
      • end point studied was a composite of death due to a cardiac cause, MI, unstable angina, and stroke. Cardiac events occurred in 13 patients (26%) in the placebo group at 6-month follow-up compared with only 4 (8%) in the atorvastatin group (p=0.31)
      • although this study was small, with few end points, and included a composite end point, the investigators did have complete follow-up, and the difference in event rates between the 2 groups was statistically significant

Continuation of statin therapy for non cardiac surgery

• there is evidence that if patients are currently taking statins and scheduled for noncardiac surgery, statins should be continue
  • O'Neil-Callahan et al. evaluated the association between statin use and cardiac complications during noncardiac surgery
    • collected information on all patients undergoing major vascular surgery (carotid endarterectomy, aortic surgery, or lower-extremity revascularization) between January 1999 and December 2000 at a single tertiary referral center
    • composite end point for this study included death, MI, ischemia, congestive HF, and ventricular tachyarrhythmias
      • primary end point occurred in 157 of 1163 patients, significantly more frequently in patients not receiving statin therapy (16.5%) than in those receiving statins (9.9%, p=0.001)
      • after adjustment for other predictors of perioperative cardiac events, statin use remained associated with a decreased risk (OR 0.52, 95% CI 0.35 to 0.76, p=0.001). These authors found that statin use was associated with beta-blocker use, but a propensity score analysis suggested that the effect of statins was independent of that association.

Reference:

• 1) Hindler K et al. Improved postoperative outcomes associated with preoperative previous termstatinnext term therapy. Anesthesiology 2006;105:1260-1272.
• 2) Durazzo AE et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004;39:967-975
• 3) O'Neil-Callahan K 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;45:336-342.