Statin Timing May Improve Heart Surgery Outcomes

A new study suggests that statin use 24 hours or less preoperatively is associated with decreased 30-day all-cause mortality after coronary artery bypass graft (CABG) surgery.

Researchers at Baylor College of Medicine and the Texas Heart Institute conducted a retrospective study of 3,025 primary CABG surgery patients in order to examine the effect of preoperative statin administration on mortality risk. The patients were divided into three groups, according to timing of preoperative statin: 24 hours or less (1,788 patients), 24-72 hours (452 patients), or more than 72 hours before surgery or no dose (781 patients). The patients were then regrouped by preoperative dose: no statin (739 patients), 20 mg or less (920 patients), or more than 20 mg (1,284 patients).

The results showed that 30-day all-cause mortality was significantly lower for patients taking statin 24 hours or less preoperatively (1.7%), compared with 24-72 hours (2.9%), and more than 72 hours or no dose (3.8%). For preoperative statin dose, 30-day all-cause mortality was significantly lower when taking 20 mg or less (1.8%) or more than 20 mg statin (2.1%) than when taking none (3.8%). A statin dose of 20 mg preoperatively was associated with a 68% reduction of 30-day all-cause mortality; however, a 20 mg or less preoperative dose showed no mortality reduction. The study was published on March 16, 2017, in The Annals of Thoracic Surgery.

“Patients frequently forget to take their pills on the day of surgery, or they've been told to stop certain medications,” said senior author cardiovascular anesthesiologist Wei Pan, MD, of the Texas Heart Institute. “This study shows that not taking your statin for even one day before cardiac surgery may increase your risk of death after surgery. Based on our findings, we would advise patients to continue taking their statin medication all the way up to and including the day of surgery.”

According to the U.S. Centers for Disease Control and Prevention, cholesterol-lowering medication is used by 28% of Americans over the age of 40, and statins account for more than 90% of these drugs. Statins also have immunomodulatory and peripheral anti-inflammatory properties that are independent of their lipid-lowering action, which could explain their effect following CABG surgery, which is associated with an intense systemic inflammatory response linked to a range of postoperative complications.