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J Thorac Cardiovasc Surg 2006;131:520-522
© 2006 The American Association for Thoracic Surgery

Editorial

Should all patients receive statins before cardiac surgery: Are more data necessary?

Department of Cardiothoracic Surgery, the Boston Medical Center, and the Boston University School of Medicine, Boston, Mass

Received for publication September 29, 2005; revisions received October 12, 2005; accepted for publication October 20, 2005.

^_* Address for reprints: Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Boston Medical Center, 88 East Newton St, Boston, MA 02118 (Email: harold.lazar@bmc.org).

The first 300 words of the full text of this article appear below.

In this issue of the Journal, Clark and coworkers ¹ conclude that pretreatment with statins before cardiac surgery decreases perioperative morbidity and mortality. The beneficial effects of statins were seen primarily in patients undergoing coronary artery bypass grafting (CABG). Although perioperative mortality was lower in valve patients receiving statins, this did not reach statistical significance, most likely because of reduced sample size.

There were several important limitations in the design of this study. It was retrospective and nonrandomized, and variable doses and types of statins were used. We are not told what the length of treatment was before surgical intervention. Furthermore, the dosages of statins were not targeted to achieve a specific low-density lipoprotein (LDL) level, as suggested by the most recent Adult Treatment Panel guidelines. ² In fact, LDL levels were not reported for either group, and therefore it is not known whether the beneficial effects of statins were due to cholesterol lowering or to their pleiotropic properties. Although propensity score analyses were used to match the patients, it is obvious that the patients who received statins also received a higher incidence of ß-blockers, angiotensin-converting enzyme inhibitors, and aspirin therapy. In short, they had more complete cardioprotection, and although statistical analyses were undertaken to account for these discrepancies, the perception is that statin-treated patients were better prepared for surgical intervention and were more aggressively treated for risk factors by their internists and cardiologists. Studies have clearly demonstrated that patients receiving the combination of statins, angiotensin-converting enzyme inhibitors, ß-blockers, and aspirin have significantly better survival after an acute coronary event.

Can we therefore conclude from this study that all patients undergoing cardiac surgery should receive statin therapy preoperatively? Should prospective randomized studies be performed to define the optimal dose, length of therapy, and specific statin for the cardiac surgical patient? Are . . . [Full Text of this Article]

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J. Thorac. Cardiovasc. Surg. 2006 131: 679-685. [Abstract] [Full Text] [PDF]

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