According to the Centers for Disease Control and Prevention (CDC), cholesterol-lowering medication is used by 28% of Americans over the age of 40, and statins account for more than 90% of these drugs.
Dr. Amr F. Baraka, from the Cleveland Clinic Foundation, OH, took a look at the effects of statins on a number of cardiac surgery outcomes.
Currently, it is common practice to stop statin use before and after surgery. Dr. Baraka's team wanted to investigate whether this pause in statin use was indeed beneficial, or if a continued program of statins might improve patient outcomes.
The review is the latest in a growing line of studies investigating statin's usage around the time of surgery. The review backs up previous findings and adds additional evidence.
It seems that surgical guidelines for the safe usage of statins might soon be changed.
What are statins?
Cholesterol is an essential ingredient in the cell walls of animals, but in large amounts, it can wreak havoc on health. Statins substantially reduce cholesterol levels by interrupting its production.
Statins inhibit an enzyme called HMG-CoA reductase, the enzyme responsible for creating cholesterol in the liver. Statins are also believed to help the body break down and reabsorb existing cholesterol plaques that might be dotted around the blood vessels of the body.
Alongside statin's use as a cholesterol-reducer, it is also being investigated for its potential therapeutic uses in dementia, lung and prostate cancer, hypertension and other diseases.
Statins and surgery
Heart surgery canidates often have a number of medical issues and, consequently, use a number of prescription drugs. Some medications can interact with the anesthetic used during surgery and may have other negative interactions. For this reason, prior to an operation, it is recommended that many medications are stopped, including statins.
Dr. Baraka, in conjunction with a team from the University of Florida in Gainesville, reviewed relevant research on Medline. They examined statin use before and after coronary artery bypass grafting and evaluated the outcomes.
Coronary artery bypass grafting procedures, as with any major surgery, can cause a serious inflammatory reaction. This inflammation can lead to postoperative complications.
The present review showed that statin use before surgery was well tolerated and that the benefits, including a reduction of atrial fibrillation, outweighed any potential negative side effects.
Although statins are predominantly utilized for their cholesterol-reducing prowess, they also have anti-inflammatory activities and promote blood flow; this could be the origin of their beneficial outcomes.
Dr. Baraka says:
"Previous research has shown that discontinuation of the medication at the time of surgery is common practice. The results of our review call for proactive efforts to counsel patients and surgeons about the benefit of statins - a benefit that definitely outweighs the risk of rare potential side effects."
The research could not define what statin dosage might be optimal; more research will be necessary before full recommendations can be rolled out.
"The current evidence suggested that the benefit of statin use in reducing the risk of stroke, heart attack, or kidney problems after surgery is not well established," says Dr. Baraka. "Further research is needed to study these associations to determine if the benefits of statins expand beyond cardiac complications."
Previous investigations into pre-operative statinsThis report adds further weight to previous work investigating the same question. A Cochrane review published in August 2015 found that the use of statins before cardiac surgery "resulted in a reduction in postoperative atrial fibrillation and a shorter stay both on the ICU and in the hospital."
The Cochrane team also found that pretreatment was associated with a reduction in myocardial infarction and renal failure, but these findings were not statistically significant.
Another study published in the European Heart Journal in September 2015 looked at the statin question from a slightly different angle. The trial reported on the outcomes of more than 15,000 patients undergoing non-cardiac operations.
The team concluded that, even in patients who were not having heart-based interventions, statins had a positive influence on recovery:
"Pre-operative statin therapy was independently associated with a lower risk of cardiovascular outcomes at 30 days."
The authors of the European Heart Journal study ended their paper with a call for larger studies. Dr. Baraka's work is just that; it adds another chunk of evidence supporting statin's safety and its benefits in conjunction with surgery.
Medical News Today recently reported on research showing that negative news stories about statins add to heart health risks.