Perioperative Rosuvastatin in Cardiac Surgery

Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael R.S.; Chen, Zhengming; Collins, Rory; Casadei, Barbara

doi:10.1056/nejmoa1507750

Cited by 286 publications

(262 citation statements)

References 35 publications

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“…87 Short-term peri-operative statin therapy increased blood levels of creatinine consistent with acute kidney injury in some randomized trials in cardiac surgery. 273,274 However, in large randomized controlled trials of long-term statinbased therapy, excesses of renal failure were not observed: for example, acute-onchronic renal failure in the SHARP trial among people who already had chronic kidney disease when randomized: 209 (6.7%) cases on simvastatin 20 mg plus ezetimibe 10 mg daily versus 231 (7.4%) cases on placebo (risk ratio 0.91; 95% CI 0.75-1.09); 275 renal failure or impairment in the Heart Protection Study among people with pre-existing cardiovascular disease or diabetes: 65 (0.6%) cases on simvastatin 40mg daily versus 60 (0.6%) cases on placebo (risk ratio 1.07; 95% CI 0.76-1.52); 276 and renal failure in the JUPITER trial in the primary prevention setting: 71 (0.9%) cases on rosuvastatin 20mg daily versus 70 (0.9%) cases on placebo (risk ratio 1.01; 95% CI 0.73-1.41). 246 Consequently, as with differences in the rates of other outcomes that have been associated with statin use in observational studies, the randomized controlled trial evidence does not provide support for an adverse effect of statin therapy on the kidney (except perhaps in the peri-operative setting) and, instead, indicates that it may slow the progression of renal impairment (although the clinical significance of the small effect that has been observed is uncertain).…”

Section: Kidney-related Outcomesmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms SummaryThis review is intended to help clinicians, patients and the public make informed decisions about statin therapy for the prevention of heart attacks and strokes. It explains how the evidence that is available from randomized controlled trials yields reliable information about both the efficacy and safety of statin therapy. In addition, it discusses how claims that statins commonly cause adverse effects reflect a failure to recognise the limitations of other sources of evidence about the effects of treatment.Large-scale randomized trial evidence shows that statin therapy reduces the risk of heart attacks, ischaemic strokes and coronary revascularization procedures ("major vascular events") by about one quarter for each mmol/L reduction in low density lipoprotein (LDL) cholesterol during each year (after the first) that it continues to be taken. The absolute benefits of statin therapy depend on an individual's absolute risk of occlusive vascular events and the absolute reduction in LDL cholesterol that is achieved. For example, lowering LDL cholesterol by 2 mmol/L (77 mg/dL) with an effective low-cost statin regimen (e.g. atorvastatin 40 mg daily, costing about £2 per

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Section: Kidney-related Outcomesmentioning

confidence: 99%

Interpretation of the evidence for the efficacy and safety of statin therapy

et al. 2016

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“…Three recent, high‐quality, randomized clinical trials, including this study's parent trial, have demonstrated that perioperative statin treatment does not reduce postoperative AKI and may, in fact, be harmful 27, 39, 40. The evidence suggests that statins should not be initiated in the perioperative period to reduce AKI.…”

Section: Discussionmentioning

confidence: 87%

High‐Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery

Smith

Blume

Linton

et al. 2017

JAHA

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BackgroundAcute kidney injury (AKI) after cardiac surgery is associated with increased short‐ and long‐term mortality. Inflammation, oxidative stress, and endothelial dysfunction and damage play important roles in the development of AKI. High‐density lipoproteins (HDLs) have anti‐inflammatory and antioxidant properties and improve endothelial function and repair. Statins enhance HDL's anti‐inflammatory and antioxidant capacities. We hypothesized that a higher preoperative HDL cholesterol concentration is associated with decreased AKI after cardiac surgery and that perioperative statin exposure potentiates this association.Methods and ResultsWe tested our hypothesis in 391 subjects from a randomized clinical trial of perioperative atorvastatin to reduce AKI after cardiac surgery. A 2‐component latent variable mixture model was used to assess the association between preoperative HDL cholesterol concentration and postoperative change in serum creatinine, adjusted for known AKI risk factors and suspected confounders. Interaction terms were used to examine the effects of preoperative statin use, preoperative statin dose, and perioperative atorvastatin treatment on the association between preoperative HDL and AKI. A higher preoperative HDL cholesterol concentration was independently associated with a decreased postoperative serum creatinine change (P=0.02). The association between a high HDL concentration and an attenuated increase in serum creatinine was strongest in long‐term statin‐using patients (P=0.008) and was further enhanced with perioperative atorvastatin treatment (P=0.004) and increasing long‐term statin dose (P=0.003).ConclusionsA higher preoperative HDL cholesterol concentration was associated with decreased AKI after cardiac surgery. Preoperative and perioperative statin treatment enhanced this association, demonstrating that pharmacological potentiation is possible during the perioperative period.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique Identifier: NCT00791648.

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“…Leczenie statyną w okresie okołooperacyjnym wydawało się zmniejszać ryzyko pooperacyjnego AF w kilku małych RCT [689,690], ale w kontrolowanej placebo próbie klinicznej, która miała odpowiednią moc statystyczną, nie wykazano wpływu okołooperacyjnego leczenia rosuwastatyną na wystę-powanie AF w okresie pooperacyjnym [691]. Leczenie statyną nie zapobiega również AF w innych sytuacjach klinicznych [692,693].…”

Section: Antyarytmiczne Działanie Leków Nieantyarytmicznychunclassified

“…Mimo początkowych doniesień z metaanaliz [689,932,933] przedoperacyjne leczenie statyną nie zapobiegało AF w okresie pooperacyjnym w prospektywnej, kontrolowanej próbie klinicznej [934]. Inne metody leczenia również oceniano w małych próbach klinicznych generujących nowe hipotezy badawcze, ale nie wykazano jednoznacznie ich korzystnych efektów.…”

Section: Prewencja Migotania Przedsionków W Okresie Pooperacyjnymunclassified