Margot J. Fromer

Preoperative statin therapy reduces the risk of early all-cause mortality for patients undergoing cardiac surgery, according to results of a meta-analysis of 19 studies with more than 30,000 patients.

These results led the authors to “advocate an intensified preoperative statin treatment, followed by a rigorous postoperative reinitiation regimen in hyperlipaemic patients with multiple cardiac risks and coronary heart disease.”

This largest meta-analysis to date was undertaken by Dr. Oliver J. Liakopoulos, department of cardiothoracic surgery, University Hospital of Cologne (Germany), and his associates and was published online by the European Heart Journal (doi:10.1093/eurheartj/ehn198).

Statins are known to prevent a variety of cardiovascular events and death by lowering lipids and improving endothelial function. However, less than half of all patients who could benefit from these drugs preoperatively receive them. Evidence suggests that their use in patients undergoing noncardiac surgery improves postoperative outcome, but in cardiac patients, results have not been as straightforward.

Dr. Liakopoulos and associates conducted the meta-analysis with the primary objective of determining if statins reduce early all-cause mortality and decrease major postoperative adverse events, including myocardial infarction, atrial fibrillation, and stroke.

They searched electronic databases and located 19 studies (with 31,725 patients) that met all the eligibility criteria. Of that total, 54.2% were receiving preoperative statin therapy of various types, dosages, regimens, and follow-up periods.

Patients who received preoperative statins had a significantly lower incidence of 30-day all-cause mortality, at 2.2%, compared with controls, at 3.7%, for an absolute risk reduction of 1.5%. The relative risk reduction in the statin-pretreated patients was 43%, a significant difference.

The incidence of myocardial infarction was 4.2% in the pretreated patients 3.9% in control patients, a nonsignificant difference.

Atrial fibrillation, the most common of the studied outcomes, occurred in 24.9% of patients treated with a statin before surgery, compared with 29.2% of patients who were not, for a 4.3% absolute risk reduction and a 33% relative risk reduction, both statistically significant reductions.

The rate of stroke also was significantly lower in the statin-pretreated group, compared with the control patients, at 2.1% and 2.9%, respectively, for a relative risk reduction of 26%.

Patients receiving preoperative statins were more likely to be younger, of male gender, have had previous infarction, be diabetic, and have received a β-blocker or aspirin prior to surgery.

This meta-analysis “adds important evidence that may settle the ongoing controversies arising from previous cardiac surgery trials,” wrote the researchers. But it has limitations: an unequal distribution of potentially confounding factors, such as β-blocker and aspirin therapy before surgery, inability to distinguish between lipid-lowering or pleiotropic actions on treatment effects, the high variability of statin dose and treatment regimens, and differences in study quality.

Preoperative statin therapy reduces the risk of early all-cause mortality for patients undergoing cardiac surgery, according to results of a meta-analysis of 19 studies with more than 30,000 patients.

These results led the authors to “advocate an intensified preoperative statin treatment, followed by a rigorous postoperative reinitiation regimen in hyperlipaemic patients with multiple cardiac risks and coronary heart disease.”

This largest meta-analysis to date was undertaken by Dr. Oliver J. Liakopoulos, department of cardiothoracic surgery, University Hospital of Cologne (Germany), and his associates and was published online by the European Heart Journal (doi:10.1093/eurheartj/ehn198).

Statins are known to prevent a variety of cardiovascular events and death by lowering lipids and improving endothelial function. However, less than half of all patients who could benefit from these drugs preoperatively receive them. Evidence suggests that their use in patients undergoing noncardiac surgery improves postoperative outcome, but in cardiac patients, results have not been as straightforward.

Dr. Liakopoulos and associates conducted the meta-analysis with the primary objective of determining if statins reduce early all-cause mortality and decrease major postoperative adverse events, including myocardial infarction, atrial fibrillation, and stroke.

They searched electronic databases and located 19 studies (with 31,725 patients) that met all the eligibility criteria. Of that total, 54.2% were receiving preoperative statin therapy of various types, dosages, regimens, and follow-up periods.

Patients who received preoperative statins had a significantly lower incidence of 30-day all-cause mortality, at 2.2%, compared with controls, at 3.7%, for an absolute risk reduction of 1.5%. The relative risk reduction in the statin-pretreated patients was 43%, a significant difference.

The incidence of myocardial infarction was 4.2% in the pretreated patients 3.9% in control patients, a nonsignificant difference.

Atrial fibrillation, the most common of the studied outcomes, occurred in 24.9% of patients treated with a statin before surgery, compared with 29.2% of patients who were not, for a 4.3% absolute risk reduction and a 33% relative risk reduction, both statistically significant reductions.

The rate of stroke also was significantly lower in the statin-pretreated group, compared with the control patients, at 2.1% and 2.9%, respectively, for a relative risk reduction of 26%.

Patients receiving preoperative statins were more likely to be younger, of male gender, have had previous infarction, be diabetic, and have received a β-blocker or aspirin prior to surgery.

This meta-analysis “adds important evidence that may settle the ongoing controversies arising from previous cardiac surgery trials,” wrote the researchers. But it has limitations: an unequal distribution of potentially confounding factors, such as β-blocker and aspirin therapy before surgery, inability to distinguish between lipid-lowering or pleiotropic actions on treatment effects, the high variability of statin dose and treatment regimens, and differences in study quality.

Preoperative statin therapy reduces the risk of early all-cause mortality for patients undergoing cardiac surgery, according to results of a meta-analysis of 19 studies with more than 30,000 patients.

These results led the authors to “advocate an intensified preoperative statin treatment, followed by a rigorous postoperative reinitiation regimen in hyperlipaemic patients with multiple cardiac risks and coronary heart disease.”

This largest meta-analysis to date was undertaken by Dr. Oliver J. Liakopoulos, department of cardiothoracic surgery, University Hospital of Cologne (Germany), and his associates and was published online by the European Heart Journal (doi:10.1093/eurheartj/ehn198).

Statins are known to prevent a variety of cardiovascular events and death by lowering lipids and improving endothelial function. However, less than half of all patients who could benefit from these drugs preoperatively receive them. Evidence suggests that their use in patients undergoing noncardiac surgery improves postoperative outcome, but in cardiac patients, results have not been as straightforward.

Dr. Liakopoulos and associates conducted the meta-analysis with the primary objective of determining if statins reduce early all-cause mortality and decrease major postoperative adverse events, including myocardial infarction, atrial fibrillation, and stroke.

They searched electronic databases and located 19 studies (with 31,725 patients) that met all the eligibility criteria. Of that total, 54.2% were receiving preoperative statin therapy of various types, dosages, regimens, and follow-up periods.

Patients who received preoperative statins had a significantly lower incidence of 30-day all-cause mortality, at 2.2%, compared with controls, at 3.7%, for an absolute risk reduction of 1.5%. The relative risk reduction in the statin-pretreated patients was 43%, a significant difference.

The incidence of myocardial infarction was 4.2% in the pretreated patients 3.9% in control patients, a nonsignificant difference.

Atrial fibrillation, the most common of the studied outcomes, occurred in 24.9% of patients treated with a statin before surgery, compared with 29.2% of patients who were not, for a 4.3% absolute risk reduction and a 33% relative risk reduction, both statistically significant reductions.

The rate of stroke also was significantly lower in the statin-pretreated group, compared with the control patients, at 2.1% and 2.9%, respectively, for a relative risk reduction of 26%.

Patients receiving preoperative statins were more likely to be younger, of male gender, have had previous infarction, be diabetic, and have received a β-blocker or aspirin prior to surgery.

This meta-analysis “adds important evidence that may settle the ongoing controversies arising from previous cardiac surgery trials,” wrote the researchers. But it has limitations: an unequal distribution of potentially confounding factors, such as β-blocker and aspirin therapy before surgery, inability to distinguish between lipid-lowering or pleiotropic actions on treatment effects, the high variability of statin dose and treatment regimens, and differences in study quality.