Got statins? UF cardiologists recommend new use for old drug
Cardiologists at the University of Florida are pointing to a new use for an old therapy. Giving patients cholesterol-lowering statins before surgery and other invasive procedures can halve the risk of heart attacks, deaths and other complications, they report in the Journal of the American College of cardiology.
“The magnitude of benefit we found in terms of reducing mortality, post-procedure myocardial infarctions and reduction in atrial fibrillation after bypass surgery is really quite large,” said first author David Winchester, M.D., a cardiology fellow in the College of Medicine’s department of medicine. “If you look at some of the other interventions we use, such as using beta blockers before surgery, you don’t get nearly the kind of benefit that we are seeing with using statins prior to procedures. That is very surprising.”
The results strongly support the routine use of statin therapy before invasive procedures, experts say.
Statins are known for their ability to lower cholesterol. But a different mechanism is at play in reduction of postsurgery complications. Although researchers have not pinpointed the specifics, they have clues about how statins work to benefit patients after surgery.
After invasive procedures such as coronary artery angioplasty, coronary bypass surgery or major vascular surgery, the risk of heart attack is raised thanks to a combination of factors. Just the act of inserting wires and catheters directly into major blood vessels can cause physical damage to those vessels or dislodge unstable plaques that then travel in the bloodstream and restrict blood flow to the very artery that cardiologists and surgeons are trying to mend.
In addition, as blood vessels try to minimize the impact of the damage, various inflammation-causing hormones and bioactive compounds are released into the circulation.
So statins may work to reduce the risk of cardiac events after surgery by stabilizing plaques and decreasing inflammation, the researchers speculate. Statins also appear to contribute to the overall health of the coronary artery.
The researchers, led by Anthony A. Bavry, M.D., M.P.H., pulled together previously published data on more than 4,800 patients from 21 different randomized, controlled trials that investigated the use of statin therapy before invasive procedures.
Called a meta-analysis, the pooling and re-analyzing of data from several individual studies allowed the researchers to study the effects of statin use on a much larger scale than would be feasible in a single study. Such a large study population enables researchers to draw stronger conclusions about the value and relative benefit of the therapy.
They found that patients who took the therapy before surgery had a 43 percent lower risk of heart attack and 46 percent lower risk of atrial fibrillation. Postsurgery death rates were lower by 34 percent. Beneficial effects were seen when statins were administered as little as one day before surgery.
“The analysis is really compelling — it should be the final nail to convince people that we need to do this. What are we waiting for?” said Kim A. Eagle, M.D., the Albion Walter Hewlett professor of internal medicine and director of the University of Michigan Cardiovascular Center, who was not involved in the current study. “I’m hopeful this will convince caregivers that this is not an accident, but that it’s a physiology that’s understandable and we need to do this.”
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