Preoperative Statins Improve Post-Surgical AAA Survival

Administering statins prior to abdominal aortic aneurysm (AAA) repair is associated with higher long-term survival, according to a new study.

Researchers at Beth Israel Deaconess Medical Center (BIDMC; Boston, MA, USA), Massachusetts General Hospital (MGH; Boston, USA), and other institutions conducted a registry-based study that included 37,950 patients that underwent AAA repairs (29,257 endovascular and 8,693 open) without documented statin intolerance. The primary analysis evaluated associations between preoperative statin therapy and long-term mortality, 30-day mortality, in-hospital myocardial infarction (MI), and in-hospital stroke. In all, 69% of the patients were taking a statin before surgery.

The results revealed that preoperative statin therapy was not associated with 30-day death, stroke, or MI. However, patients taking statins preoperatively showed higher one and five year survival, compared with those who were not. Of those not taking a statin preoperatively and discharged alive, 24% started on a statin before discharge. Again, the results revealed that patients that initiated statin therapy before discharge experienced higher survival at one and five years, with the greatest survival difference seen in patients with rupture (87% versus 62%). The study was published in the August 2018 issue of the Journal of Vascular Surgery.

“Preoperative statin therapy is associated with higher long-term survival but not perioperative mortality and morbidity in patients undergoing AAA repair, and initiating statin therapy in previously statin-naive patients is associated with markedly higher survival,” concluded lead author Thomas O'Donnell, MD, of BIDMC, and colleagues. “All patients with AAAs without contraindications should receive statin therapy. In patients not taking a statin at the time of AAA repair, clinicians should consider initiating one before discharge.”

According to the U.S. Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA), 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 AAA surgery.

Related Links:
Beth Israel Deaconess Medical Center
Massachusetts General Hospital
U.S. Centers for Disease Control and Prevention