Cochrane: Pre-op statins may help patients undergoing cardiac surgery

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Pre-operative statin therapy can reduce the chance of post-operative atrial fibrillation and shortens the stay on the intensive care unit (ICU) and in the hospital in patients who undergo cardiac surgery, based on a systematic review published April 17 in the Cochrane Database of Systematic Reviews. However, statin pre-treatment had no influence on the risk of dying, stroke, heart attack or kidney failure around the time of the operation.

During the past decade, overall mortality within 30 days of surgery has remained constant worldwide at approximately 3 percent to 4 percent, wrote the study authors. “If outcomes among cardiac surgery patients are to be improved, development of better strategies that limit the risk of major adverse events after cardiac procedures is imperative,” they continued. “HMG-CoA reductase inhibitors (statins) effectively reduce the risk of atherosclerotic cardiovascular disease through lipid-lowering actions.”

Before this study, it was unclear whether patients who are about to undergo heart surgery would benefit if they took statins before the operation.

A team of researchers based at the University of Cologne in Cologne, Germany, analyzed data in 11 randomized controlled trials that evaluated the impact of pre-operative statin intake on the reduction of major adverse events in patients undergoing cardiac surgery. These studies included a total of 984 participants who were undergoing different forms of heart surgery.

Oliver J. Liakopoulos, MD, of the department of cardiothoracic surgery at the University of Cologne's Heart Centre, and colleagues found that giving statins before surgery reduced the incidence of post-operative atrial fibrillation (AF), suggesting a beneficial effect for patients with a statin treatment when compared to patients without a statin therapy. In addition, they discovered that patients who had statins before the operation tended to leave the ICU about three-and-a half hours earlier, and left hospital about half a day earlier.

There was, however, no significant reduction in the proportion of people who had a heart attack or kidney failure subsequently. Furthermore, statins had no effect on the number of people who died or had a stroke soon after the operation. 

“[A] pre-operative statin therapy is beneficial for patients undergoing cardiac surgical procedures in terms of a reduction of postoperative AF and a potential benefit in terms of a shorter stay both on the ICU and in the hospital,” the researchers concluded. “[T]he beneficial effects of statins presumably overbalances the inherent risks that are associated with a statin pre-treatment.”

They pointed to one limitation of their findings. “Since the data we analyzed had come mainly from patients having coronary artery bypass operations, the results cannot be extrapolated to patients undergoing other cardiac procedures such as heart valve or aortic surgery,” Liakopoulos said in a statement.

At the same time, the researchers emphasized the need for more data. “To get a clearer picture of the potential benefits of taking statins before a heart operation, we need to have more clinical trials and find out whether clinical outcomes can be further improved if patients use special statin dosing regimens shortly before a heart procedure,” said Liakopoulos.

“In light of an increasing proportion of patients referred to cardiac surgery presenting with multiple comorbidities that potentially precipitate the development of adverse outcomes after surgery, the pre-treatment with statins needs to be investigated in these high-risk patient cohorts,” the study authors concluded.

There was no source of funding for this work, according to the study authors.