Meta-Analysis of Patients Taking Statins Before Revascularization and Aortic Valve Surgery

Kuhn, Elmar; Liakopoulos, Oliver J.; Stange, Sebastian; Deppe, Antje‐Christin; Slottosch, Ingo; Scherner, Maximilian; Choi, Yeong‐Hoon; Wahlers, Thorsten

doi:10.1016/j.athoracsur.2013.04.096

Cited by 25 publications

(18 citation statements)

References 52 publications

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“…Recent evidence, including our own data, suggests that PARP cleavage is a critical factor in post-ischemic brain injury and represents a useful biomarker for neuroprotective drug efficacy in pharmacotherapy of diseases with an H/R component. Therefore, our data with atorvastatin suggests that pretreatment with statins may limit hypoxic injury and reduce the incidence of associated neurological deficits, as can occur following coronary artery bypass grafting (Kuhn et al, 2013; Kulik & Ruel, 2009). …”

Section: Pathophysiology Of Ischemiamentioning

confidence: 78%

Drug Delivery to the Ischemic Brain

Thompson

Ronaldson

2014

Advances in Pharmacology

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Cerebral ischemia occurs when blood flow to the brain is insufficient to meet metabolic demand. This can result from cerebral artery occlusion that interrupts blood flow, limits CNS supply of oxygen and glucose, and causes an infarction/ischemic stroke. Ischemia initiates a cascade of molecular events inneurons and cerebrovascular endothelial cells including energy depletion, dissipation of ion gradients, calcium overload, excitotoxicity, oxidative stress, and accumulation of ions and fluid. Blood-brain barrier (BBB) disruption is associated with cerebral ischemia and leads to vasogenic edema, a primary cause of stroke-associated mortality. To date, only a single drug has received US Food and Drug Administration (FDA) approval for acute ischemic stroke treatment, recombinant tissue plasminogen activator (rt-PA). While rt-PA therapy restores perfusion to ischemic brain, considerable tissue damage occurs when cerebral blood flow is re-established. Therefore, there is a critical need for novel therapeutic approaches that can “rescue” salvageable brain tissue and/or protect BBB integrity during ischemic stroke. One class of drugs that may enable neural cell rescue following cerebral ischemia/reperfusion injury is the HMG-CoA reductase inhibitors (i.e., statins). Understanding potential CNS drug delivery pathways for statins is critical to their utility in ischemic stroke. Here, we review molecular pathways associated with cerebral ischemia and novel approaches for delivering drugs to treat ischemic disease. Specifically, we discuss utility of endogenous BBB drug uptake transporters such as organic anion transporting polypeptides (OATPs/Oatps) and nanotechnology-based carriers for optimization of CNS drug delivery. Overall, this chapter highlights state-of-the-art technologies that may improve pharmacotherapy of cerebral ischemia.

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Section: Pathophysiology Of Ischemiamentioning

confidence: 78%

Drug Delivery to the Ischemic Brain

Thompson

Ronaldson

2014

Advances in Pharmacology

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“…Furthermore, PST was associated with 3.39 hours decrease in the length of intensive care unit stay compared to control (weighted mean difference of À3.39 hours; 95% CI, À5.77 to À0.01; p ¼ 0.005) [70]. Similarly, Kuhn and coworkers [44] demonstrated in their metaanalysis a positive effect of PST on the length of hospital stay (weighted mean difference of À0.30 days; 95% CI, À0.51 to À0.09; p < 0.01). The analysis included eight studies reporting the length of stay with a total of 1,082 patients.…”

Section: Preoperative Statin Therapy and Length Of Hospital Staymentioning

confidence: 96%

“…Similar association was shown by Oddsson and coworkers [43], in which PST significantly reduced the odds of operative mortality (OR, 0.33; 95% CI, 0.11 to 0.88; p ¼ 0.046). Subsequent metaanalyses examining the effect of PST on mortality after CABG showed a significant reduction in short-term mortality with statins [44][45][46]. More recently, Sanders and colleagues [47] illustrated in a large observational study, which included more than 16…”

Section: Preoperative Statin Therapy and All-cause Mortalitymentioning

confidence: 99%

“…Although statins were shown to decrease the incidence of myocardial infarction after percutaneous coronary intervention and noncardiac operations, this effect was not proven in post-CABG patients [44,46,48,49]. Possible explanations include attenuation of the pleiotropic effect of statins with chronic use [50].…”

Section: Preoperative Statin Therapy and Myocardial Infarctionmentioning

confidence: 99%

“…Another study by Bouchard and associates [62], which included 6,813 patients who underwent CABG at a single institution during a decade, showed that the combination of statin and betablocker therapy, but not statin alone, was protective against post-CABG stroke (OR, 0.38; 95% CI, 0.15 to 0.97; p ¼ 0.044). Later on, Kuhn and colleagues [44] conducted a large meta-analysis of 32 studies (including 10 randomized controlled trials [RCTs]) that analyzed the effect of PST in isolated CABG patients. Sixteen studies with a total of 24,707 patients had stroke as an end point.…”

Section: Preoperative Statin Therapy and Stroke Or Transient Ischemicmentioning

confidence: 99%

See 2 more Smart Citations

Perioperative Statin Therapy for Patients Undergoing Coronary Artery Bypass Grafting

Barakat

Saad

Abu‐Zaid

et al. 2016

The Annals of Thoracic Surgery

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Coronary artery bypass grafting is associated with an intense systemic inflammatory response, which is linked to postoperative complications. Beyond lipid lowering, statins exert a constellation of beneficial actions, including an antiinflammatory role, known as pleiotropic effects. There is increasing evidence that perioperative statin therapy improves outcomes in patients undergoing coronary artery bypass grafting. Statins are underused in the coronary artery bypass grafting population, because perioperative discontinuation remains a common practice. This article provides an extensive review of the available literature on the effect of perioperative statin therapy on post–coronary artery bypass grafting outcomes and weighs the evidence for the concerns about increased incidence of statin-related adverse effects in this setting.

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Statins and Perioperative Mortality

Říha

Drábek

2016

Reducing Mortality in the Perioperative Period

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Meta-Analysis of Patients Taking Statins Before Revascularization and Aortic Valve Surgery

Cited by 25 publications

References 52 publications

Drug Delivery to the Ischemic Brain

Drug Delivery to the Ischemic Brain

Perioperative Statin Therapy for Patients Undergoing Coronary Artery Bypass Grafting

Statins and Perioperative Mortality

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