Statins Reduce Deaths And Strokes After Carotid Surgery

Statins taken for a week before carotid endarterectomy surgery can reduce the risk of near-term death by 80%, and the risk of early stroke by 65%, say Johns Hopkins researchers.

Bruce A. Perler, M.D., chief of vascular surgery at the Johns Hopkins Hospital, said, "We found that among patients on statins, the 30-days stroke incidence was only 1.2%, versus 4.5% among patients who were not taking statin drugs, a highly statistically significant difference." "The operative or 30-day mortality among patients on statins was only 03%, as opposed to about 2% among patients who were not taking statin drugs - again, a highly statistically significant difference," Dr. Perler added. Dr. Perler presented the results of a retrospective chart review during a briefing at the AMA's annual science reporters' conference.

Carotid endarterectomy is the most frequently performed peripheral vascular surgery procedure, with about 160,000 to 180,000 operations in the U.S. annually.

Although an endarterectomy can significantly reduce the risk of stroke, "even in the best of hands, 1% to 5% of patients will have a stroke as a result of the surgery," Dr. Perler said. "If we can cut that in half or by two-thirds, that's important."

To evaluate whether the use of statins could reduce the rate of perioperative stroke and death, he and colleagues reviewed the charts of 1,566 patients with a mean age of 72 plus or minus 10, who underwent carotid endarterectomy at their center between 1994 and 2004. Endarterectomy alone was performed for 1,440 patients (92%), and combined endarterectomy and coronary artery bypass graft (CABG) was performed for126.

In all, 657 of the patients (42%) had taken a statin for at least one week before surgery. These patients were significantly more likely than non-statin users to have cardiovascular risk factors, including hypertension, high cholesterol, coronary artery disease, history of smoking, and male gender. Symptomatic disease was the primary indication for surgery in 660 (42%) of the patients.

The authors found that use of any statin for at least one week before surgery was associated with a significant reduction in perioperative strokes, 1.2% vs. 4.5% (P < .01).

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Patients on statins also had significantly fewer transient ischemic attacks, 1.5% vs. 3.6%; P < .01), and a lower incidence of all-cause mortality, 0.3% vs 2.1% (P < .01).

Statin users had shorter median hospital stays (two days, range two to five days) compared with those who didn't take statins (three days, range two to seven days, P < .05).