Patients who take statins before and after heart bypass surgery have fewer complications and a reduced risk of dying during and soon after the operation, a new analysis finds.
In a review of recent studies on the use of statins (such as Lipitor or Zocor) before and after bypass surgery, researchers found that the cholesterol-lowering drugs reduced the incidence of the abnormal heartbeat atrial fibrillation by 58 percent. In addition, statins also reduced the risk of dying in the hospital after the operation by 43 percent.
“We think statins have these effects because they reduce inflammation,” said researcher Dr. Islam Elgendy, of the division of cardiovascular medicine at the University of Florida, Gainesville.
“Right after bypass surgery, there is intense inflammation of the heart,” he added. “Perhaps starting statins two weeks before the surgery reduces the level of inflammation.”
The report was published online Jan. 12 and in the February print issue of the Annals of Thoracic Surgery.
Heart bypass surgery is an operation that uses blood vessels from another part of the body to go around — or “bypass” — blocked or narrowed heart arteries, allowing more blood and oxygen to flow to the heart muscle, according to the American Heart Association.
But while the researchers found statins were well-tolerated by patients before bypass surgery, they also found they are vastly underused.
In one study reviewed by Elgendy’s team, only about 37 percent of the patients were given statins before surgery. In many cases, heart patients are told to stop taking statins before bypass surgery, Elgendy said.
This review calls that practice into question, he added.
Some surgeons worry that statins can cause serious side effects, such as muscle pain or muscle damage, Elgendy explained. “However, we found that these side effects are very minimal and the benefits are greater than discontinuing the medication,” he said.
Elgendy recommends that patients start taking a statin before bypass surgery if they are not taking one, and continue taking a statin if they are already doing so.
In addition, he recommends that all patients continue taking statins after the operation.
Dr. Gregg Fonarow is a cardiology professor at the University of California, Los Angeles. Fonarow, who was not involved with the new review, said, “Current guidelines recommend that all patients with cardiovascular disease, including those patients undergoing coronary [heart] bypass surgery, receive statin therapy to lower the risk of fatal and nonfatal cardiovascular events.”
High-dose statin therapy is recommended in all such patients under the age of 75, and moderate or high dosing of statins for those over 75, Fonarow said.
Beyond the intermediate and long-term benefits of statin therapy, he added, a number of studies have suggested there may be additional benefits of starting or continuing statin therapy after bypass surgery.
“Despite all the evidence and current guidelines, there are still many patients undergoing bypass surgery who are not receiving statin therapy, and this represents an important opportunity to improve care and outcomes for this patient population at risk,” Fonarow said.
For more on coronary bypass surgery, visit the U.S. National Institutes of Health.