Mortality in coronary artery bypass graft surgery lowered by preoperative statin treatment

by Bruce Sylvester: A study of the protective effect of heart medications that patients receive before coronary artery bypass graft (CABG) surgery suggests that statins reduce the risk of death by 67 percent, while no consistent prophylactic effects appeared for other medications.

The research was presented on May 31, 2015 at the European Society of Anaesthesiology (Euroanaesthesia 2015).

“Statins were associated with a significant protective effect on perioperative mortality from CABG surgery that was not shared by the other cardiovascular medications. Further data are needed on whether all statins exert similar effects,” said Robert Sanders, M.D., assistant professor, Department of Anesthesiology, University of Wisconsin, Madison, Wisconsin, USA

Dr Sanders was joined in the research by Dr Puja Myles and Dr Sudhir Venkatesan, both of the University of Nottingham, UK, and with collaborators at the University of Southampton, Royal Brompton Hospital, London and University Hospital South Manchester NHS Trust, all in the UK.

The team conducted a retrospective analysis of data from the United Kingdom Clinical Practice Research Datalink on 16,192 patients aged 40 years and over who had undergone CABG surgery.

To determine the effects of each medication, they researchers utilized statistical models accounting for factors that might affect perioperative mortality, such as history of other chronic illnesses, medications and comorbidities.

Patient use of statins was most prevalent (85 percent of patients), followed by beta-blockers (73 percent), ACE inhibitors (60 percent), calcium channel blockers (43 percent) and alpha-2 agonists (1 percent).

For each of the five statistical models employed in the analysis, statin users achieved a statistically significant protective effect against perioperative mortality, with the likelihood of death reduced from between 65 and 74 percent.

Simvastatin, the mostly commonly prescribed statin, reduced the likelihood of death by 77 percent.

The researchers found no consistent effects on perioperative mortality for other medications studied – beta-blockers, ACE inhibitors, calcium channel blockers and alpha-2 agonists.

Dr Sanders added, “In combination with previous studies, these data suggest that patients not taking statins should be considered for statin therapy based on their perioperative and chronic health risks. Consistent evidence of benefit or harm of the other drugs was not observed. Further data on the relative benefits of individual statin drugs are required — however this study suggests that at least simvastatin offers protection.”