Statin Withdrawal After Vascular Surgery May be Hazardous

Patients who discontinue statin therapy for a relatively brief period while undergoing and recovering from vascular surgery have an increased risk for adverse cardiac events, according to new study.

Researchers at Erasmus Medical Center (Rotterdam, the Netherlands) obtained detailed cardiac histories on 298 consecutive statin users who underwent major vascular surgery. Troponin levels were measured on postoperative days 1, 3, 7, and 30, and whenever clinically indicated by electrocardiographic (ECG) changes. End points included postoperative troponin release (myocardial damage), nonfatal myocardial infarction (MI), and a combination of nonfatal MI and cardiovascular death. Statin therapy was interrupted in the perioperative period in 70 patients (23%) for a mean duration of three days.

The researchers found that 26.8% of the entire cohort experienced myocardial damage, 11.4% experienced myocardial infarction, and 3.0% died. An association was observed between statin discontinuation and an increased risk for postoperative troponin release and the combination of MI and cardiovascular death. Patients who were receiving extended-release fluvastatin had fewer perioperative cardiac events compared to those receiving atorvastatin, simvastatin, and pravastatin. The study was published in the July 15, 2007, issue of the American Journal of Cardiology.

"Patients who undergo major vascular surgery frequently are not able to take oral medications shortly after surgery, for example, because of postoperative paralytic ileus,” said lead author Dr. Don Poldermans, from the department of cardiology.

"Fluvastatin is the only statin with an extended-release formula,” Dr. Poldermans and colleagues explained. Because most patients with statin withdrawal restarted statin therapy less than three to four days after surgery, it might be hypothesized that the extended-release fluvastatin formula is capable of extending the duration of the pleiotropic effects of statins.”


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