Midterm Benefits of Preoperative Statin Therapy in Patients Undergoing Isolated Valve Surgery

Vaduganathan, Muthiah; Stone, Neil J.; Andrei, Adin Cristian; Lee, Richard; Kansal, Preeti; Silverberg, Robert A.; Bonow, Robert O.; McCarthy, Patrick M.

doi:10.1016/j.athoracsur.2012.02.091

Cited by 9 publications

(21 citation statements)

References 20 publications

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“…Six studies described the effect of preoperative statin therapy on early mortality and 3 studies assessed mortality at mid‐late follow‐up . In the largest study to date, Angeloni et al observed an independent association between preoperative statin therapy and lower in‐hospital and mid‐term mortality (odds ratio [OR]: 0.48, 95% confidence interval [CI]: 0.32‐0.89, P = 0.001 and 4.1% vs 6.1% at 24 months, P = 0.04), supporting Tabata et al's 2008 findings (Table ) .…”

Section: Summary Of Search Resultsmentioning

confidence: 64%

“…Our search identified 9 studies investigating the role of preoperative statins in isolated valve surgery (IVS) and valve surgery in conjunction with CABG . These studies reviewed a total of 18 154 patients as summarized in the Table .…”

Section: Summary Of Search Resultsmentioning

confidence: 99%

“…Mortality: Six studies described the effect of preoperative statin therapy on early mortality 33,36,37,38,39,40 and 3 studies assessed mortality at mid-late follow-up. 32,33,39 In the largest study to date, Angeloni et al 33 observed an independent association between preoperative statin therapy and lower in-hospital and mid-term mortality (odds ratio [OR]: 0.48, 95% confidence interval [CI]: 0.32-0.89, P = 0.001 and 4.1% vs 6.1% at 24 months, P = 0.04), supporting Tabata et al's 2008 findings (Table 1). 38 Most recently, Vaduganathan et al were also able to show a significant reduction in 30-day mortality with preoperative statins (1.3% vs 4.2%; P = 0.03) as well as a trend toward lower long-term mortality (7.3% vs 11.5%, P = 0.06) at a mean follow-up of 32.9 ± 22.5 months.…”

Section: Statins In Isolated Valve Surgerymentioning

confidence: 99%

“…38 Most recently, Vaduganathan et al were also able to show a significant reduction in 30-day mortality with preoperative statins (1.3% vs 4.2%; P = 0.03) as well as a trend toward lower long-term mortality (7.3% vs 11.5%, P = 0.06) at a mean follow-up of 32.9 ± 22.5 months. 39 Conversely, however, a similar number of studies report conflicting evidence. Neither the work by Virani (N = 825) nor that by Folkeringa (N = 272) was able to demonstrate an improvement in 30-day mortality with statin therapy.…”

Section: Statins In Isolated Valve Surgerymentioning

confidence: 99%

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Can Statins Improve Outcomes After Isolated Cardiac Valve Surgery? A Systematic Literature Review

Chacko

Harling

Ashrafian

et al. 2013

Clinical Cardiology

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Background HMG CoA (3‐hydroxy‐3‐methylglutaryl coenzyme A) reductase inhibitors, or statins, have been associated with an improvement in outcomes after coronary artery surgery for some time; however, their role in isolated valve surgery (IVS) remains undetermined. Hypothesis The pleiotropic effects of statins may produce similar beneficial effects on outcomes after IVS. Methods A systematic review of the literature was performed investigating the role of statins in bioprosthetic valve replacement. Results Nine observational studies (7 retrospective, 2 prospective) incorporating a total of 18 154 patients were found investigating the role of statin therapy in bioprosthetic valve replacement. Conclusions There is presently insufficient evidence to recommend routine statin therapy in IVS, unless concomitant hypercholesterolemia or coronary artery disease is present. A prospective study clearly defining the dose, type, and duration of therapy is now required to finally clarify whether statins alone confer a postoperative benefit in these patients.

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Section: Summary Of Search Resultsmentioning

confidence: 64%

Section: Summary Of Search Resultsmentioning

confidence: 99%

Section: Statins In Isolated Valve Surgerymentioning

confidence: 99%

Section: Statins In Isolated Valve Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Can Statins Improve Outcomes After Isolated Cardiac Valve Surgery? A Systematic Literature Review

Chacko

Harling

Ashrafian

et al. 2013

Clinical Cardiology

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“…When obese and non-obese patients were stratified depending on the use of statins, interestingly we found a significantly enhanced coronary dilation in obese subgroups, with our without statin, when responses were compared to non-obese patients with no statin treatment. Previous studies by Vaduganathan et al found pre- and perioperative statin therapy to be associated with reduced mid-term mortality in patients undergoing heart surgery [20,21]. Recent randomized studies by Antoniades et al demonstrated that pre-operative atorvastatin treatment (40 mg/day for three days) improved saphenous vein relaxations, effects that were independent from the lipid-lowering properties of the drug [22,23].…”

Section: Discussionmentioning

confidence: 99%

Obesity and statins are both independent predictors of enhanced coronary arteriolar dilation in patients undergoing heart surgery

Cassuto

Fehér

Lan

et al. 2013

J Cardiothorac Surg

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BackgroundA paradoxical inverse relationship between body mass index, morbidity and mortality in patients with ischemic heart disease has been noted; but the underlying mechanisms remain unclear. Given that coronary resistance arteries are the primary regulators of myocardial blood flow, we examined the effects of obesity and medication on dilator function in coronary microvessels.MethodsBradykinin-induced coronary dilation was assessed by videomicroscopy in ex vivo coronary arterioles obtained from 64 consecutive patients undergoing heart surgery. Multi-variable linear regression and logistic regression were used to investigate the effects of obesity (BMI ≥ 30 kg/M2) and the influences of medications on vessel responses.ResultsIn isolated, pressurized (80 mmHg) coronary arterioles of obese and non-obese patient the active (73±4 vs. 79±13 μm) and passive (111 ± 5.5 vs. 118 ± 5.0 μm) diameters were similar. Bradykinin elicited substantial dilation in coronary arterioles, with a similar magnitude in obese and non-obese patients (to 10-8 M: 55 ± 5% vs. 46 ± 5%, P = 0.20), but with significantly enhanced sensitivity in obesity (EC50: 8.2x10-9 M vs. 1.9x10-8 M, respectively, P = 0.03). When adjusted for other risk factors and medications, obesity and statins were determined to be the only positive predictors of enhanced dilation, as assessed with multiple regression analysis. Moreover, obese patients with or without statin exhibited significantly increased coronary dilation to bradykinin, when compared to non-obese patients without statin therapy.ConclusionsObesity and statin therapy are independently associated with an enhanced dilator function of coronary arterioles in patients undergoing heart surgery, which may offer a potential mechanism for the better cardiovascular outcome described earlier as the obesity paradox.

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Do Statins Attenuate Postoperative Atrial Fibrillation in Isolated Heart Valve Surgery?

et al. 2016

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Midterm Benefits of Preoperative Statin Therapy in Patients Undergoing Isolated Valve Surgery

Cited by 9 publications

References 20 publications

Can Statins Improve Outcomes After Isolated Cardiac Valve Surgery? A Systematic Literature Review

Can Statins Improve Outcomes After Isolated Cardiac Valve Surgery? A Systematic Literature Review

Obesity and statins are both independent predictors of enhanced coronary arteriolar dilation in patients undergoing heart surgery

Do Statins Attenuate Postoperative Atrial Fibrillation in Isolated Heart Valve Surgery?

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