Cholesterol Rx May Benefit Bypass Surgery

Coronary artery bypass surgery results may improve if receiving statin therapy beforehand

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) To reduce “bad” cholesterol, patients commonly take medications called statins. Receiving this treatment before bypass surgery may reduce the risk of post-surgery complications.

High levels of low-density lipoproteins (LDL), or "bad" cholesterol, can cause blockages in arteries or atherosclerosis (hardening of the arteries). While statins can help lower LDL levels and prevent clogged arteries, individuals may still require surgical procedures to improve heart function.

Two of the most frequently performed heart surgeries are coronary artery bypass graft (CABG) and aortic valve replacement (AVR).

In a new study, scientists found that patients who took statins before CABG had lower chances of dying, stroke and atrial fibrillation after surgery, but the same benefits didn't apply to AVR patients.

"Ask your doctor how to prepare for heart bypass surgery."

Elmar Kuhn, MD, and Oliver Liakopoulos, MD, both in the Department of Cardiothoracic Surgery, Heart Center, University of Cologne in Germany, co-led an analysis of 32 previous studies evaluating statin treatment before CABG surgery and representing a total of 36,053 patients.

These researchers also reviewed results from four reports on the effects of statins in 3,091 patients who had AVR surgery.

With CABG surgery, a healthy artery or vein from the body is connected, or grafted, to a blocked coronary artery to restore blood flow.

With AVR, a patient receives a new mechanical or biological heart valve in place of a valve that is not efficiently pumping blood.

Based on outcomes from the various studies, the investigators calculated that patients who took statins — which include brand names such as Lipitor, Lescol, Mevacor, Crestor, Pravachol and Zocor — before CABG lowered their odds of dying by about one-third compared to those who did not take the medication.

Overall, individuals who received statins lowered their stroke risk by 19 percent compared to non-statin takers.

Those who had statin treatment prior to CABG surgery had about 23 percent incidence of atrial fibrillation versus 24 percent for those not receiving statins.

Those who had statin treatment prior to AVR surgery, however, had no significant benefits from taking statins.

“Our result underlines the importance of statin therapy before CABG procedures,” said Dr. Liakopoulos in a press release.

“We therefore hope that more patients are treated with statins prior to bypass surgery, but recognize that our work may not impact the current care for patients undergoing aortic valve replacement. In general, we believe these results can prompt greater efforts to improve preoperative management,” Dr. Liakopoulos said.

The American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines urges that all patients undergoing CABG surgery, regardless of their LDL levels before surgery, receive statin treatment.

"As outlined by the article, statin therapy alone in the modern era has significantly decreased risk of heart attack and stroke in the US. Multiple studies have now shown more than 33% decrease in heart attack and approximately 20% decrease in stroke for patients using statin therapy before open heart by-pass surgery," David Brown, MD, an interventional cardiologist at The Heart Hospital Baylor Plano where he is director of interventional cardiology and co-director of cardiovascular research and the structural heart program, told dailyRx News.

This study was published on October 1 in The Annals of Thoracic Surgery.

Review Date: 
September 30, 2013
Last Updated:
October 3, 2013