Statin Use Reduces Cardiovascular Deaths in Vascular Surgery Patients

A new study has found that using extended-release fluvastatin perioperatively in patients undergoing vascular surgery for peripheral artery disease (PAD) led to a nearly 50% reduction in myocardial ischemia (MI).

Researchers from the Erasmus Medical Center (Rotterdam, The Netherlands) conducted a randomized placebo-controlled trial of 497 statin-naive patients scheduled to undergo vascular surgery. The patients were randomized to a sustained-release formulation of fluvastatin 80-mg-per-day (250 patients) or placebo (247 patients) an average of 37 days prior to surgery, between June 2004 and April 2008. The statin was continued for at least the first 30 days after surgery. The primary end point was MI, as assessed by a combination of continuous electrocardiogram (ECG) monitoring in the first 72 hours, followed by intermittent troponin-T measurements and further ECGs until the end of follow-up, on day 30. The combined secondary end point was cardiac death or nonfatal MI.

The study results showed that there was a clear reduction in the primary end point among those taking fluvastatin; 30 days after surgery, 27 patients in the statin group (10.9%) had MI compared with 47 (18.9%) in the placebo group. Similarly, the combined secondary end point of cardiac death or nonfatal MI was significantly reduced among those taking the statin; 12 (4.8%) of those taking fluvastatin met this end point compared with 25 (10.1%) of those on placebo. The results of the study were presented at the 2008 European Society of Cardiology (ESC) Congress, held during August-September 2008 in Munich (Germany).

"We believe that coronary plaque rupture is responsible for at least half of these fatalities. If you want to improve outcomes, it's wise to start statins early before surgery because you have additional gain. That's something people should know,” said study presenter Don Poldermans, M.D. "If their patients have PAD and are undergoing vascular surgery, although they might not have an increased cholesterol level, they still benefit from statins, not only from the outset but long-term, so don't wait until after surgery to start.”

The researchers believe the benefits of the fluvastatin were at least partly due to its pleiotropic effects, since levels of the inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) levels, which were similar between the two groups at baseline, were significantly reduced in those taking the statin just before surgery. CRP was down by 21% in the statin group compared with a 3% increase in those on placebo and IL-6 levels were reduced by 33% in the active-treatment group compared with 4% in the placebo group.

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