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CC BY 4.0 · Aorta (Stamford) 2021; 09(04): 147-154
DOI: 10.1055/s-0041-1730296
Original Research Article

Statin Therapy in Patients Undergoing Thoracic Aorta Replacement for Aortic Aneurysms

Bogdan A. Kindzelski
1   Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
,
Andrea L. Hanick
1   Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
,
Kyle G. Miletic
1   Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
,
Ashley M. Lowry
2   Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
,
David Van Wagoner
3   Department of Molecular Cardiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
,
Eugene H. Blackstone
1   Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
2   Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
,
Eric E. Roselli
1   Aorta Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
› Author Affiliations Funding This study was supported by The Stephens Family Endowed Chair in Cardiothoracic Surgery.
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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.

Keywords

statins - thoracic aortic aneurysm surgery - postoperative renal failure

Supplementary Material



Publication History

Received: 14 September 2020

Accepted: 26 February 2021

Article published online:
08 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Stone NJ, Robinson JG, Lichtenstein AH. et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129 (25, Suppl 2): S1-S45
    CrossrefPubMedGoogle Scholar
  • 2 Davignon J. Beneficial cardiovascular pleiotropic effects of statins. Circulation 2004; 109 (23, Suppl 1): III39-III43
    CrossrefPubMedGoogle Scholar
  • 3 Aboyans V, Labrousse L, Lacroix P. et al. Predictive factors of stroke in patients undergoing coronary bypass grafting: statins are protective. Eur J Cardiothorac Surg 2006; 30 (02) 300-304
    CrossrefPubMedGoogle Scholar
  • 4 Tabata M, Khalpey Z, Pirundini PA, Byrne ML, Cohn LH, Rawn JD. Renoprotective effect of preoperative statins in coronary artery bypass grafting. Am J Cardiol 2007; 100 (03) 442-444
    CrossrefPubMedGoogle Scholar
  • 5 Levack MM, Aftab M, Roselli EE. et al. Outcomes of a less-invasive approach for proximal aortic operations. Ann Thorac Surg 2017; 103 (02) 533-540
    CrossrefPubMedGoogle Scholar
  • 6 Jacobs JP, Yohe C, Krantz J, Blackstone EH. Documentation of vital status in the United States of America. J Thorac Cardiovasc Surg 2017; 154 (02) 644-646
    CrossrefPubMedGoogle Scholar
  • 7 Rajeswaran J, Blackstone EH. Identifying risk factors: Challenges of separating signal from noise. J Thorac Cardiovasc Surg 2017; 153 (05) 1136-1138
    CrossrefPubMedGoogle Scholar
  • 8 Rubin DB. Multiple Imputation for Non-Response in Surveys. New York, NY: Wiley; 1987
    CrossrefGoogle Scholar
  • 9 Blackstone EH, Naftel DC, Turner Jr ME. The decomposition of time-varying hazard into phases, each incorporating a separate stream of concomitant information. J Am Stat Assoc 1986; 81: 615-624
    CrossrefPubMedGoogle Scholar
  • 10 Nagashima H, Aoka Y, Sakomura Y. et al. A 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor, cerivastatin, suppresses production of matrix metalloproteinase-9 in human abdominal aortic aneurysm wall. J Vasc Surg 2002; 36 (01) 158-163
    CrossrefPubMedGoogle Scholar
  • 11 Karrowni W, Dughman S, Hajj GP, Miller Jr FJ. Statin therapy reduces growth of abdominal aortic aneurysms. J Investig Med 2011; 59 (08) 1239-1243
    CrossrefPubMedGoogle Scholar
  • 12 Angeloni E, Vitaterna A, Pirelli M, Refice S. Effects of statin therapy on ascending aorta aneurysms growth: a propensity-matched analysis. Int J Cardiol 2015; 191: 52-55
    CrossrefPubMedGoogle Scholar
  • 13 Takagi H, Matsui M, Umemoto T. A meta-analysis of clinical studies of statins for prevention of abdominal aortic aneurysm expansion. J Vasc Surg 2010; 52 (06) 1675-1681
    CrossrefPubMedGoogle Scholar
  • 14 Takagi H, Yamamoto H, Iwata K, Goto S, Umemoto T. ALICE (All-Literature Investigation of Cardiovascular Evidence) Group. Effects of statin therapy on abdominal aortic aneurysm growth: a meta-analysis and meta-regression of observational comparative studies. Eur J Vasc Endovasc Surg 2012; 44 (03) 287-292
    CrossrefPubMedGoogle Scholar
  • 15 Steinmetz EF, Buckley C, Shames ML. et al. Treatment with simvastatin suppresses the development of experimental abdominal aortic aneurysms in normal and hypercholesterolemic mice. Ann Surg 2005; 241 (01) 92-101
    CrossrefPubMedGoogle Scholar
  • 16 Luan Z, Chase AJ, Newby AC. Statins inhibit secretion of metalloproteinases-1, -2, -3, and -9 from vascular smooth muscle cells and macrophages. Arterioscler Thromb Vasc Biol 2003; 23 (05) 769-775
    CrossrefPubMedGoogle Scholar
  • 17 Li Y, Lu G, Sun D, Zuo H, Wang DW, Yan J. Inhibition of endoplasmic reticulum stress signaling pathway: a new mechanism of statins to suppress the development of abdominal aortic aneurysm. PLoS One 2017; 12 (04) e0174821
    CrossrefPubMedGoogle Scholar
  • 18 Jovin IS, Duggal M, Ebisu K. et al. Comparison of the effect on long-term outcomes in patients with thoracic aortic aneurysms of taking versus not taking a statin drug. Am J Cardiol 2012; 109 (07) 1050-1054
    CrossrefPubMedGoogle Scholar
  • 19 Stein LH, Berger J, Tranquilli M, Elefteraides JA. Effect of statin drugs on thoracic aortic aneurysms. Am J Cardiol 2013; 112 (08) 1240-1245
    CrossrefPubMedGoogle Scholar
  • 20 Verdoodt A, Honore PM, Jacobs R. et al. Do statins induce or protect from acute kidney injury and chronic kidney disease: an update review in 2018. J Transl Int Med 2018; 6 (01) 21-25
    CrossrefPubMedGoogle Scholar
  • 21 Wang J, Gu C, Gao M, Yu W, Yu Y. Preoperative statin therapy and renal outcomes after cardiac surgery: a meta-analysis and meta-regression of 59,771 patients. Can J Cardiol 2015; 31 (08) 1051-1060
    CrossrefPubMedGoogle Scholar
  • 22 Zhao BC, Shen P, Liu KX. Perioperative statins do not prevent acute kidney injury after cardiac surgery: a meta-analysis of randomized controlled trials. J Cardiothorac Vasc Anesth 2017; 31 (06) 2086-2092
    CrossrefPubMedGoogle Scholar
  • 23 Putzu A, de Carvalho E Silva CMPD, de Almeida JP. et al. Perioperative statin therapy in cardiac and non-cardiac surgery: a systematic review and meta-analysis of randomized controlled trials. Ann Intensive Care 2018; 8 (01) 95
    CrossrefPubMedGoogle Scholar
  • 24 Zheng Z, Jayaram R, Jiang L. et al. Perioperative rosuvastatin in cardiac surgery. N Engl J Med 2016; 374 (18) 1744-1753
    CrossrefPubMedGoogle Scholar
  • 25 Tyerman Z, Hawkins RB, Mehaffey JH. et al. Preoperative statin use not associated with improved outcomes after ascending aortic repair. Semin Thorac Cardiovasc Surg 2018; 30 (04) 421-426
    CrossrefPubMedGoogle Scholar