Statins Improve Results of Vascular Surgery

A new study demonstrates that lipid-lowering therapies could stabilize coronary plaques and improve vascular surgery postoperative outcome.

Researchers at the Erasmus Medical Center (EMC; Rotterdam, The Netherlands) hypothesized that this effect was anti-inflammatory in nature, as opposed to an effect directly related to the statin's lipid-lowering efficacy. To test this conjuncture, they conducted a double blind, placebo-controlled trial, in which statin-naive patients were randomly assigned to receive either 80 mg of extended release fluvastatin or a matched placebo, starting 37 days prior to surgery; a total of 250 patients were assigned to fluvastatin and 247 to placebo. To assess the influence on inflammation markers by statin therapy interleukin-6 (IL-6) and C-reactive protein (CRP) were measured at randomization and immediately prior to surgery.

The study results showed that IL-6 and CRP concentrations remained stable in the placebo group and decreased in the fluvastatin group. The incidence of myocardial infarction (MI) in the fluvastatin and placebo allocated groups was 10.8% compared to 19%, and the incidence of the composite cardiac death and MI was 4.8% compared to 10.2%, respectively. The study was presented at the Veith Symposium, held in New York (NY, USA) during November 2008.

"Fluvastatin therapy was associated with a reduction of inflammation activity and improved postoperative cardiac outcome in elective vascular surgery patients," concluded study presenter Professor Don Poldermans, M.D., and colleagues at the Erasmus Medical Center.

Statins form a class of hypolipidemic drugs used to lower cholesterol levels in people with or at risk of cardiovascular disease. They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver stimulates low-density lipoprotein (LDL) receptors, resulting in an increased clearance of LDLs from the bloodstream and a decrease in blood cholesterol levels. The first results can be seen after one week of use and the effect is maximal after four to six weeks.

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