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Reducing Perioperative Events During Vascular Surgery

Am Fam Physician. 2010 Feb 1;81(3):333.

Background: Patients undergoing noncardiac vascular surgery have a high risk of postoperative cardiac events attributed to underlying coronary artery disease and related inflammation. Other studies have shown that statins can reduce inflammation; therefore, it is possible that they could also prevent coronary plaque rupture, even in patients who have not required statin therapy for hyperlipidemia.

The Study: For the DECREASE III (Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography III) study, Schouten and colleagues recruited patients older than 40 years who were not currently being treated with a statin and who were scheduled for non-emergent, noncardiac vascular surgery (e.g., abdominal aortic aneurysm repair, carotid endarterectomy, or aortoiliac or lower-limb arterial reconstruction). In addition to receiving perioperative beta blockers, patients were randomized to receive placebo or extended-release fluvastatin (Lescol) in a dosage of 80 mg per day. The study medication was started at a median of 37 days before surgery and continued for at least 30 days after surgery. Patients were excluded if they had unstable coronary artery disease or had undergone surgery within the previous 30 days. The primary outcome was myocardial ischemia within 30 days after surgery.

Results: Twenty-seven (10.8 percent) of the 250 patients in the fluvastatin group developed myocardial ischemia, compared with 47 (19.0 percent) of the 247 patients in the control group (hazard ratio [HR] = 0.55; number needed to treat [NNT] = 12). Patients taking fluvastatin were less likely to experience cardiovascular death or nonfatal myocardial infarction than those in the control group (4.8 versus 10.1 percent, respectively; HR = 0.47; NNT = 19). There were no significant differences in rates of creatine kinase or alanine transaminase elevation between groups.

Conclusion: The authors conclude that perioperative fluvastatin therapy, in addition to beta-blocker therapy, leads to significant improvement in the rates of postoperative cardiac outcomes in patients undergoing noncardiac vascular surgery.

KENNETH T. MOON, MD

Source

Schouten O, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med. September 3, 2009;361(10):980–989.


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