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Statins May Cut Death Risk After Surgery

Study finds benefit after any type of operation

TUESDAY, May 4, 2004 (HealthDayNews) -- Giving cholesterol-lowering statin drugs to everyone who has any kind of surgery could save lives, new research indicates.

A study of more than 780,000 surgical patients found a significantly lower death rate among those who were given statins in the day or two before the operation -- 2.13 percent, compared to 3.05 percent for those who didn't get the drugs, said a report in the May 5 issue of the Journal of the American Medical Association.

Previous studies have found statins reduce risks for patients who have heart surgery. This one was limited to noncardiac surgery, and it got essentially similar results.

The benefits don't appear to be due primarily to the ability of statins to lower blood cholesterol levels, said study author Dr. Peter K. Lindenauer, an assistant professor of medicine at the Baystate Medical Center in Springfield, Mass.

Instead, the drugs act in other ways to reduce the risk that surgery will trigger a heart attack or other major cardiovascular problem that could be fatal, he said.

Statins have been shown to help reduce formation of artery-clogging clots, to have a soothing effect on the delicate endothelial tissue that lines blood vessels, and to lower blood levels of C-reactive protein, a marker of the inflammatory process that can cause a fat-laden plaque deposit to tear loose from the artery wall, he said.

"It is believed that death can be caused by the rupture of unstable plaque when it is exposed to stress around the time of surgery," Lindenauer said. "We hypothesize that statins may have a beneficial effect in the postoperative period, helping to stabilize plaque."

But it is "far too early" to make a blanket recommendation for statins in surgery, he said. The new report comes from an observational study, "and that is subject to bias," Lindenauer said. "Clearly what we need at this point is a controlled clinical trial."

"Observational" means that the study covered the experience of a large number of patients for whom data were available -- in this case, people who had any noncardiac operation at 329 hospitals in the United States in the years 2000 and 2001.

Just under 10 percent of those patients were given statins in the first two days after they were admitted to the hospital before surgery. The mortality rate for those patients was 28 percent lower than for patients who did not get statins, the researchers reported.

But a number of questions need answers before any recommendation is made about use of statins in surgery, Lindenauer said -- for example, how far in advance of the operation should drug treatment be started.

Despite its limitations, the report is a valuable "hypothesis-generating study," said Dr. Albert W. Chan, associate director of the catheterization laboratory at the Ochsner Clinic Foundation in New Orleans.

Chan has reported a study showing that statins improve the outcome for patients undergoing artery-opening procedures such as angioplasty. Those results cannot be applied to all surgery patients, he said.

"The reason is that patients who have heart disease need to be on statins anyway," Chan said. "We would have to look at people who do not need statins. Such a study would include people with no coronary disease. We would have to test that group to see if adding statins before surgery saves lives or not."

That trial would have to include "a large number of people," Chan said. He said he knows of no plans for such a study.

More information

The everyday role of statins is described by the American Heart Association. Get tips on what to ask your doctor before surgery from the Agency for Healthcare Research and Quality.

SOURCES: Peter K. Lindenauer, M.D., assistant professor, medicine, Baystate Medical Center, Springfield, Mass.; Albert W. Chan, M.D., associate director, catheterization laboratory, Ochsner Clinic Foundation, New Orleans; May 5, 2004, Journal of the American Medical Association
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