Statins Can Positively Impact Surgical Recovery

Prescribing statins in the early perioperative period is associated with reduced postoperative complications and mortality, according to a new study.

Researchers at the University of California, San Francisco (UCSF; USA), the University of Colorado (Boulder, USA), and other institutions conducted a retrospective, observational cohort analysis of 180,478 U.S. veterans who were admitted to department of Veterans Affairs (VA) hospitals for elective or emergent non-cardiac surgery between 2005 and 2010. The total study cohort comprised 96,486 surgeries, of which 37.8% held an active prescription for statins, with simvastatin being the most commonly prescribed medication.

The results showed that statin use provided a reduced risk in all complications during the recovery process, except for the central nervous system (CNS) and thrombosis categories, with the greatest risk reduction being in the area of cardiac complications. In addition, after adjustment for risk, other medications used, and potential selection biases, the researchers found that 30-day mortality was also significantly reduced in the statin-exposed group. The study was published on December 19, 2016, in JAMA Internal Medicine.

“While the effect was modest, a patient over 45 with some risk factors - borderline cholesterol level, hypertension - might consider discussing with his doctor starting a statin before surgery,” said lead author professor of anesthesiology Martin London, MD, of UCSF. “Hopefully, the main contribution of these data is to provide a bit more impetus to conduct randomized studies, despite their complexity and expense.”

Statins lower cholesterol levels by inhibiting the enzyme HMG-CoA reductase, which plays a central role in the production of cholesterol in the liver. Randomized controlled trials have shown that they are most effective in those with cardiovascular disease (CVD), with questionable benefit in those without previous CVD but with elevated cholesterol levels. Statins also have immunomodulatory and peripheral anti-inflammatory properties that are independent of their lipid-lowering action.

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