VIENNA — Stopping a patient's statin regimen for a few days during and after major vascular surgery was linked with a significant rise in cardiovascular death, myocardial infarction, and myocardial ischemia in a study of 298 patients from one center.
A regular statin regimen may be stopped temporarily at the time of surgery because there is no intravenous statin formulation, which means that patients must take the drug orally. Oral drugs often are halted for a few days at the time of major surgery.
“The pleiotropic effects of statins only last for a few hours or days, and that probably makes the difference in this study,” Dr. Olaf Schouten said while presenting a poster at the annual congress of the European Society of Cardiology.
The results also indicated that patients treated with an extended-release statin formulation, extended-release fluvastatin, had significantly fewer ischemic cardiac events than did patients treated with any of several conventional-release statins.
The implication is that patients who must stop a statin for surgery should restart the drug as soon as possible, said Dr. Schouten, a vascular surgeon at Erasmus Medical Center in Rotterdam, the Netherlands. The results also suggest that if stopping a statin for a few days is unavoidable, patients might fare better if they take an extended-release statin for several days before surgery starts and the regimen is stopped.
The study included 298 consecutive patients on long-term statin treatment who underwent major vascular surgery at Erasmus. About a quarter of the patients stopped their treatment for an average of 3 days, with a range of 2–8 days; the other 75% maintained treatment during and after surgery. The most common formulation used was extended-release fluvastatin, used by 100 patients. Other formulations used were simvastatin by 86 patients, atorvastatin by 77 patients, and pravastatin by 35 patients.
Because statin treatment wasn't stopped randomly, Dr. Schouten and his associates used both multivariable and propensity-score analyses to control for other variables and to assess the impact of statin discontinuation.
They found that stopping a statin was associated with a 4.6-fold increased risk of troponin release, a marker of myocardial ischemia, and with a 7.5-fold increased risk of cardiovascular death or myocardial infarction.
The analyses also showed that patients who stopped treatment with extended-release fluvastatin had significantly fewer events in the first 30 days after surgery than did patients treated with any type of immediate-release statin, including fewer deaths and myocardial infarctions as well as less troponin release. (See box.)
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