Fluvastatin Could Improve Cardiac Outcomes Following Vascular Surgery

Perioperative treatment with fluvastatin may improve cardiac outcomes after vascular surgery, according to a new study.

Researchers at the Erasmus Medical Center (Rotterdam, The Netherlands) conducted a double-blind, placebo-controlled trial, and randomly assigned patients who had not previously been treated with a statin to receive--in addition to a beta-blocker--either 80 mg of extended-release fluvastatin (250 patients) or placebo (247 patients) once daily before undergoing vascular surgery. Lipid, interleukin-6 (IL-6), and C-reactive protein (CRP) levels were measured at the time of randomization and before surgery. The primary end point was the occurrence of myocardial ischemia (MI), defined as transient electrocardiographic abnormalities, release of troponin T (or both), within 30 days after surgery. The secondary end point was the composite of death from cardiovascular causes and MI.

The researchers found that the levels of total cholesterol, low-density lipoprotein cholesterol, IL-6, and CRP were significantly decreased in the fluvastatin group, but were unchanged in the placebo group. Postoperative MI occurred in 27 patients (10.8%) in the fluvastatin group and in 47 (19.0%) in the placebo group. Death from cardiovascular causes or MI occurred in 12 patients (4.8%) in the fluvastatin group and 25 patients (10.1%) in the placebo group. Fluvastatin therapy was not associated with a significant increase in the rate of adverse events. The study was published in the September 3, 2009, issue of the New England Journal of Medicine (NEJM).

"In patients undergoing vascular surgery, perioperative fluvastatin therapy was associated with an improvement in postoperative cardiac outcome,” concluded lead author Olaf Schouten, M.D., Ph.D., and colleagues of the department of surgery. "Recent guidelines…on the management of peripheral arterial disease indicate that statin use is appropriate in patients undergoing vascular surgery, regardless of whether they have clinical risk factors. These guidelines are based on retrospective studies; the results of the current prospective trial confirm these recommendations.”

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