In the Journals

Statin therapy confers survival benefit in AAA repair

Preoperative statin therapy was associated with higher long-term survival in patients undergoing abdominal aortic aneurysm repair, researchers reported.

Statin therapy was not associated with perioperative mortality or morbidity, however.

“Our results suggest that [the 2013 American College of Cardiology/American Heart Association lipid management guidelines] need to be re-examined,” Thomas F.X. O’Donnell, MD, from the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center and the department of surgery at Massachusetts General Hospital, and colleagues wrote. “The association we found with long-term but not short-term outcomes implies that statins are not modifying the perioperative milieu; rather, the need for AAA repair is a marker of elevated risk. Consequently, we hypothesize that statin therapy in those patients does not affect their immediate postoperative course but provides secondary risk reduction similar to that seen in other atherosclerotic populations, such as patients with stroke, MI and peripheral arterial disease.”

O’Donnell and colleagues analyzed 37,950 patients from the Vascular Quality Initiative database who underwent AAA repair (29,257 endovascular) between 2003 and 2017 and did not have documented statin intolerance.

Outcomes of interest included long-term mortality, 30-day mortality, in-hospital MI and in-hospital stroke.

Overall, 69% of patients were taking a statin before their procedure, and statin use was more common in those who underwent endovascular repair vs. open repair (69% vs. 66%; P < .001), according to the researchers.

To compare the statin and nonstatin groups, the researchers conducted propensity weighting.

After propensity weighting, preoperative statin use was not associated with 30-day mortality, in-hospital MI or in-hospital stroke, O’Donnell and colleagues wrote.

Adjusted survival was higher at 1 year (94% vs. 90%; P < .001) and 5 years (85% vs. 81%; P < .001) in the statin group, the researchers found.

In a subgroup analysis, the survival differences applied only to those with intact or symptomatic aneurysms.

Of those not on a statin before the procedure and discharged alive, 24% were started on a statin before discharge. In a secondary analysis of those not on a statin before AAA repair, those started on a statin before discharge had higher 1-year (94% vs. 91%; P < .001) and 5-year (89% vs. 81%; P < .001) survival rates than those who remained off statins, O’Donnell and colleagues wrote, noting that this was driven by differences in patients with AAA rupture (87% vs. 62%; P < .001).

“Preoperative statin therapy is associated with higher long-term survival after AAA repair, and those who are naive to the drug should be considered for such therapy prior to discharge to take advantage of this benefit,” O’Donnell said in a press release. – by Erik Swain

Disclosure: One author reports he receives funding from Abbott, Cook and Endologix.

Preoperative statin therapy was associated with higher long-term survival in patients undergoing abdominal aortic aneurysm repair, researchers reported.

Statin therapy was not associated with perioperative mortality or morbidity, however.

“Our results suggest that [the 2013 American College of Cardiology/American Heart Association lipid management guidelines] need to be re-examined,” Thomas F.X. O’Donnell, MD, from the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center and the department of surgery at Massachusetts General Hospital, and colleagues wrote. “The association we found with long-term but not short-term outcomes implies that statins are not modifying the perioperative milieu; rather, the need for AAA repair is a marker of elevated risk. Consequently, we hypothesize that statin therapy in those patients does not affect their immediate postoperative course but provides secondary risk reduction similar to that seen in other atherosclerotic populations, such as patients with stroke, MI and peripheral arterial disease.”

O’Donnell and colleagues analyzed 37,950 patients from the Vascular Quality Initiative database who underwent AAA repair (29,257 endovascular) between 2003 and 2017 and did not have documented statin intolerance.

Outcomes of interest included long-term mortality, 30-day mortality, in-hospital MI and in-hospital stroke.

Overall, 69% of patients were taking a statin before their procedure, and statin use was more common in those who underwent endovascular repair vs. open repair (69% vs. 66%; P < .001), according to the researchers.

To compare the statin and nonstatin groups, the researchers conducted propensity weighting.

After propensity weighting, preoperative statin use was not associated with 30-day mortality, in-hospital MI or in-hospital stroke, O’Donnell and colleagues wrote.

Adjusted survival was higher at 1 year (94% vs. 90%; P < .001) and 5 years (85% vs. 81%; P < .001) in the statin group, the researchers found.

In a subgroup analysis, the survival differences applied only to those with intact or symptomatic aneurysms.

Of those not on a statin before the procedure and discharged alive, 24% were started on a statin before discharge. In a secondary analysis of those not on a statin before AAA repair, those started on a statin before discharge had higher 1-year (94% vs. 91%; P < .001) and 5-year (89% vs. 81%; P < .001) survival rates than those who remained off statins, O’Donnell and colleagues wrote, noting that this was driven by differences in patients with AAA rupture (87% vs. 62%; P < .001).

“Preoperative statin therapy is associated with higher long-term survival after AAA repair, and those who are naive to the drug should be considered for such therapy prior to discharge to take advantage of this benefit,” O’Donnell said in a press release. – by Erik Swain

Disclosure: One author reports he receives funding from Abbott, Cook and Endologix.