Timing, dosage of statins before heart surgery impacts survival

In a retrospective study of more than 3,000 coronary artery bypass grafting surgery patients, researchers at Baylor College of Medicine and Baylor St. Luke’s Medical Center, a part of CHI St. Luke’s Health, found that those who continued taking their cholesterol-lowering medication prior to the surgery had better survival rates than those who stopped taking their medication. Their report appears today in The Annals of Thoracic Surgery.

“Patients frequently forget to take their medications on the day of surgery, or they have been told to stop certain medications but end up stopping all their medications,” said Dr. Wei Pan, clinical associate professor of anesthesiology at Baylor College of Medicine and senior author of the paper. “This study shows that even not taking the statin for one day prior to cardiac surgery may increase your risk of death after surgery. Based on our findings, we would advise patients to continue taking their statin medication all the way up to and including the day of surgery.”

Pan and colleagues divided the patient data into three groups according to the timing of their preoperative statin use – those who took their statin medication 24 hours or less prior to surgery, those who took their medication between 24 and 72 hours before surgery and, finally, those who took their statin medication more than 72 hours prior to their surgery. They also grouped patients by their preoperative dose – no statin, 20 milligrams or less and more than 20 milligrams.

“We found that the 30-day cause of mortality was significantly lower for patients who took their statin medication 24 hours or less prior to their surgery compared to the other groups,” said Pan, who is also with the Texas Heart Institute. “In addition, taking more than 20 milligrams of the statin prior to the surgery was associated with a 68 percent reduction of 30-day all-cause mortality compared to not taking a statin.”

“The use of statins to reduce mortality in coronary artery bypass surgery has been demonstrated in clinical trials and has become accepted medical practice,” said Dr. Joseph Coselli, vice-chair of surgery and chief of cardiothoracic surgery at Baylor College of Medicine. “The American College of Cardiology and the American Heart Association both recommend its use for this purpose. This manuscript will move this knowledge forward by clarifying the time frame in which statins are most beneficial as well as the appropriate dosage. This knowledge, without question, will save many lives in patients with coronary artery disease requiring coronary bypass surgery.”

Researchers recommend that this study should be followed up by a prospectively randomized trial.

Others who took part in the study include Dr. Michael Curtis, Dr. Yi Deng, Vei-Vei Lee, Dr. MacArthur A. Elayda and Dr. Charles D. Collard, all with Baylor College of Medicine.