Perioperative statin use may improve outcomes following CABG

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For patients undergoing CABG, perioperative statin therapy may lead to improvements in systematic inflammatory response and reductions in the risk of postoperative atrial fibrillation and perioperative mortality, according to a review of published literature.

However, the use of statins was lower than the researchers expected.

Lead researcher Amr F. Barakat, MD, of the Cleveland Clinic, and colleagues published their results online in the  Annals of Thoracic Surgery.

“The current underuse of statins in the perioperative period is mainly related to concerns from physicians about the increased risk of side effects in this setting, namely statin-induced myopathy, rhabdomyolysis, and subsequent renal failure,” they wrote.

In fact, the researchers mentioned the American College of Cardiology, American Heart Association and National Heart, Lung and Blood Institute cited these concerns in guidelines starting in 2002. Package inserts for several statins also cite surgery as a risk factor for statin-induced rhabdomyolysis.

Still, the researchers referred to one study that found there was no increase in the risk of postoperative myopathy in patients who received statins. A meta-analysis also showed that there were no events associated with statins in three randomized clinical trials.

Although previous studies have shown the benefits of statins, the researchers said patients are often told to stop using statins before CABG because of concerns about stress-related adverse effects.

In this analysis, the researchers searched the Medline database from inception until July 2015 for articles related to statin therapy and entered the key words “statins” and “coronary artery bypass graft.”

They mentioned several studies that showed preoperative statin therapy was associated with reductions in all cause mortality, MI, atrial fibrillation, stroke or transient ischemic attack, acute kidney injury, renal replacement therapy and length of hospital stay.

Despite the beneficial effects of statins, one study showed that only 37.3 percent of patients received a statin prescription during the year prior to undergoing CABG. The rates were low for patients with diabetes, cerebrovascular disease and other conditions. Another trial estimated that 58.2 percent of people in the U.S. with coronary artery disease did not take statins, while a third study found that most people received lower doses of statins than were recommended by clinical trials.

The researchers mentioned atorvastatin and simvastatin were associated with the best outcomes. They added that the evidence suggested statin use was associated with attenuation of systematic inflammatory response and reduction in the risk of postoperative atrial fibrillation.

“The evidence suggests that the benefit outweighs the questionable increased likelihood of statin-induced myopathy in the setting of operation,” the researchers wrote. “Counseling patients on the importance of statin therapy is of outmost importance. The optimal statin dose and duration, and whether reloading confers additional benefit, remain areas of ongoing research.”