Peripheral Vascular Surgery and Statins

Graft patency and limb salvage were improved in patients taking statins before infra-inguinal by-pass surgery [18].

Aggressive lipid lowering may reduce the high mortality and morbidity (mainly from coronary events) associated with vascular surgery in PAD and other patients [14, 29]. Coronary events are the most important cause of long-term morbidity and mortality after peripheral vascular surgery [12, 14]. Even PAD patients without overt CHD are at significant risk of long-term cardiac events.

The effect of atorvastatin compared with placebo on the occurrence of a composite of cardiovascular events after vascular surgery was assessed [12]. Patients (n = 100) were randomly assigned to atorvastatin 20 mg once daily (n = 50) or placebo (n = 50) for 45 days, irrespective of their serum cholesterol concentration. Vascular surgery was performed on average 30 days after randomization. During the 6-month follow-up, the incidence of cardiac events was higher in the placebo compared with the ator-vastatin group [13 (26.0%) versus 4 (8.0%); p = 0.031].

In a case-control study, among patients (n = 2816) who underwent major vascular surgery, 160 (5.7%) died during their hospital stay [32]. After adjustments, statin therapy was significantly less common in the patients who died than in controls (8% versus 25%; p < 0.001). The adjusted OR for peri-operative mortality among statin users as compared with nonusers was 0.22 (95% CI = 0.10-0.47).

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