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(Circulation. 2003;107:1848.)
© 2003 American Heart Association, Inc.

Brief Rapid Communications

Statins Are Associated With a Reduced Incidence of Perioperative Mortality in Patients Undergoing Major Noncardiac Vascular Surgery

Don Poldermans, MD, PhD; Jeroen J. Bax, MD; Miklos D. Kertai, MD; Boudewijn Krenning, MD; Cynthia M. Westerhout, MD; Arend F.L. Schinkel, MD; Ian R. Thomson, MD; Peter J. Lansberg, MD; Lee A. Fleisher, MD; Jan Klein, MD; Hero van Urk, MD; Jos R.T.C. Roelandt, MD; Eric Boersma, PhD

From the Departments of Cardiology (M.D.K., B.K., C.M.W., A.F.L.S., I.R.T., J.R.T.C.R., E.B.), Vascular Surgery (D.P., H.v.U.), and Anesthesiology (J.K.), Erasmus Medical Center, Rotterdam, The Netherlands; University Hospital Leiden, Department of Cardiology, Leiden, The Netherlands (J.J.B.); University of Amsterdam, Amsterdam, The Netherlands (P.J.L.); and Department of Anesthesiology, Johns Hopkins Hospital, Baltimore, Md (L.A.F.).

Correspondence to Don Poldermans, MD, PhD, Department of Vascular Surgery, Erasmus Medical Center, Room BA 300, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. E-mail d.poldermans{at}erasmusmc.nl

Background— Patients undergoing major vascular surgery are at increased risk of perioperative mortality due to underlying coronary artery disease. Inhibitors of the 3-hydroxy-3-methylglutaryl coenzyme A (statins) may reduce perioperative mortality through the improvement of lipid profile, but also through the stabilization of coronary plaques on the vascular wall.

Methods and Results— To evaluate the association between statin use and perioperative mortality, we performed a case-controlled study among the 2816 patients who underwent major vascular surgery from 1991 to 2000 at the Erasmus Medical Center. Case subjects were all 160 (5.8%) patients who died during the hospital stay after surgery. From the remaining patients, 2 controls were selected for each case and were stratified according to calendar year and type of surgery. For cases and controls, information was obtained regarding statin use before surgery, the presence of cardiac risk factors, and the use of other cardiovascular medication. A vascular complication during the perioperative phase was the primary cause of death in 104 (65%) case subjects. Statin therapy was significantly less common in cases than in controls (8% versus 25%; P<0.001). The adjusted odds ratio for perioperative mortality among statin users as compared with nonusers was 0.22 (95% confidence interval 0.10 to 0.47). Similar results were obtained in subgroups of patients according to the use of cardiovascular therapy and the presence of cardiac risk factors.

Conclusion— This case-controlled study provides evidence that statin use reduces perioperative mortality in patients undergoing major vascular surgery.

Key Words: statins • mortality • vasculature • surgery

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