Statin Therapy in Patients Undergoing Thoracic Aorta Replacement for Aortic Aneurysms.

Eugene H Blackstone,Bogdan A Kindzelski,Andrea L Hanick,Ashley M Lowry,David Van Wagoner,Eric E Roselli,Kyle G Miletic

doi:10.1055/s-0041-1730296

Abstract

Background Patients undergoing surgery for thoracic aortic aneurysms receive statin therapy out of proportion to cardiovascular comorbidity. We sought to determine the prevalence of statin use among patients presenting for thoracic aortic aneurysm surgery and investigate its effect on outcomes. Methods From January 1, 2005 to January 1, 2011, 1,839 consecutive patients underwent aortic replacement for degenerative thoracic aortic aneurysm at Cleveland Clinic. Of these, 771 (42%) were on statins preoperatively. Statin users (vs. nonstatin users) were older (65 ± 11 vs. 56 ± 16 years) and had more hypertension (78 vs. 59%). Propensity matching based on 56 preoperative variables other than lipid levels was used to compare outcomes among 570 matched patient pairs (74% of possible pairs). Results Propensity-matched statin and nonstatin users were aged 64 ± 11 years, 394 (69%) versus 387 (68%) were male, and 437 (77%) versus 442 (78%) had ascending aortic aneurysms, respectively. Overall, 25% of patients were followed for more than 8.2 years and 10% for more than 10 years. Perioperative outcomes were similar, including hospital mortality (11 [1.9%] vs. 5 [0.88%]) and stroke (22 [3.9%] vs. 13 [2.3%]), but 16 statin users (2.8%) versus 5 nonstatin users (0.88%) required temporary dialysis after surgery ( p = 0.02). At 6 years, 3.7% of statin users versus 5.1% of nonstatin users ( p [log-rank] = 0.5) underwent further aortic surgery, and at 10 years, mortality was 25% in both groups ( p > 0.5). Conclusion Patients presenting for thoracic aortic aneurysm surgery frequently receive unnecessary statins. Additionally, statin use was associated with more postoperative renal failure, but not less intermediate-term risk for aortic reintervention or all-cause mortality after surgery. Therefore, presence of a thoracic aortic aneurysm should not be considered an indication for statin therapy in the absence of well-established indications.

Highlights

A major challenge in identifying medical therapies for thoracic aortic aneurysm has been its incompletely defined pathogenesis, we know that hemodynamic, connective tissue, inflammatory, and genetic elements are linked to its development
We have investigated the prevalence of statin use among patients presenting for thoracic aortic aneurysm surgery and the cardiovascular factors associated with it, and we evaluated its possible effects on outcomes after aorta replacement
Because cardiac catheterization was performed routinely as standard of care before surgery for thoracic aortic aneurysms, we were able to document that 318 statin users (41%) did not have coronary artery disease, peripheral arterial disease, or carotid artery disease, which we interpreted as not having a cardiovascular indication for statins

Summary

Introduction

A major challenge in identifying medical therapies for thoracic aortic aneurysm has been its incompletely defined pathogenesis, we know that hemodynamic, connective tissue, inflammatory, and genetic elements are linked to its development. Statins for abdominal aortic aneurysms have been shown to have beneficial effects in both human and animal studies[1,2,3,4] and are known to exert many pleiotropic, non–lipidlowering effects, including modulation of the inflammatory system, improved endothelial function, antioxidant properties, and maintenance of atherosclerotic plaque stability,[2] in addition to their cardioprotective effects.[1] there is widespread prophylactic use of statins in patients with thoracic aortic disease in the absence of well-established cardiovascular indications. We have investigated the prevalence of statin use among patients presenting for thoracic aortic aneurysm surgery and the cardiovascular factors associated with it, and we evaluated its possible effects on outcomes after aorta replacement. Presence of a thoracic aortic aneurysm should not be considered an indication for statin therapy in the absence of well-established indications

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Discussion

Conclusion