Statins are commonly used drugs for managing cholesterol and treating cardiovascular disease (CVD). Researchers looked at the efficacy of statin use around noncardiac operative procedures and found that they reduced all-cause mortality and risk of complications.
Statins are the most commonly prescribed drug in the United States. They are used to lower cholesterol levels by inhibiting cholesterol synthesis and promoting excretion. While they are commonly used as a preventative measure for cardiovascular disease (CVD), the efficacy of non-cardiac perioperative (encompassing preoperative, intraoperative and postoperative treatment) statin use is inconclusive.
Cholesterol is essential to human function in nerve insulation and hormone production, but it can also have adverse effects on cardiovascular function. Cholesterol levels produced by the liver are generally sufficient, but additional dietary cholesterol can lead to a build-up in the arteries (atherosclerosis), narrowing the vessels, increasing blood pressure and increasing risk of CVD. There are two types of cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL contributes to the development of atherosclerosis while HDL aids the removal of LDL. Thus, knowing the specific levels of each cholesterol is important in assessing cardiovascular health. Statins act to inhibit LDL production and increase LDL uptake, lowering levels of “bad” cholesterol.
In a new study published in JAMA Internal Medicine, London et al. examined the efficacy of early perioperative statin use to improve patient outcome in noncardiac surgical procedures. The retrospective study used a sample of veterans undergoing elective or emergent non-cardiac surgery and exposure was defined as statin use on the day of or day after surgery. Patients had to be admitted within 7 days of surgery and patients who died the day of or the day after surgery were excluded. Efficacy was evaluated via 30 day all-cause mortality and post-surgery complications occurring within 30 days including cardiac arrest, stroke, deep vein thrombosis and infection.
The findings showed a decrease in all-cause mortality and post-surgery complications, mostly cardiac-based, with statin use. Patients with ischemic heart disease or diabetes, younger than 75 years old, those undergoing high-risk surgery, and those receiving high-intensity statin treatment benefited from increased risk reduction. In addition, the perioperative removal of statin treatment was linked with adverse effects. The study was limited by a lack of information regarding prescription details and biomarker levels, particularly biomarkers adversely affected by statin use. Nonetheless, the findings suggest that perioperative statin use could result in a decreased risk of mortality and complications following noncardiac surgery.
Written By: Wesley Tin, BMSc