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Monday, September 7, 2009

Statins Before Surgery

Benefits of Statins Before Vascular Surgery

Rick and I have quipped frequently in the four years we've been doing PodMed that soon statins, that class of drugs used to lower cholesterol, will be added to drinking water, a lot like fluoride. That's because in many reports and studies, the benefits of statins seem legion. Now comes a study in NEJM showing another benefit. When people have vascular surgery, or surgery on their blood vessels, those who receive statins experience fewer cardiovascular events than those who don't: Fluvastatin and Perioperative Events in Patients Undergoing Vascular Surgery.

People who need vascular surgery are at high risk for subsequent heart attacks and other cardiac events, some of them resulting in death. This study took 499 patients and started about half of them on a statin almost 40 days prior to surgery, with the other half not receiving the drug. Patients were followed for 30 days following surgery.

Those who took the statin experienced about half the rate of heart attack or death from a cardiac event than those who did not take the statin. As might be expected, statin takers had reduced cholesterol and blood markers of inflammation than those who did not. While no one knows exactly why statins have this beneficial effect, this last is a common hypothesis: they reduce inflammation and its consequences.

What does this mean for statin use prior to surgery? Clearly, surgery on this group of people was planned and allowed for initiation of statin therapy well before surgery took place. That's not a luxury everyone who will undergo surgery has, and no one knows how helpful the drugs might be in an acute setting. Also, this benefit is only seen in folks who are not taking statins already, as so many people are. Yet the fact remains that statins once again seem to offer additional benefits besides lowering cholesterol, and no doubt more will emerge as studies are reported.

Other studies we discuss in this week's podcast include Injectable Collagenase Clostridium Histolyticum for Dupuytren's Contracture, also in NEJM, and two studies in this week's JAMA: Treatment of Bell Palsy and Chronic Pelvic Pain and Nerve Ablation (hyperlinks not available at time of blog posting). Until next week, y'all live well.

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