Home' Australian Pharmacist : Australian Pharmacist June 2012 Contents 460 Australian Pharmacist June 2012 I ©Pharmaceutical Society of Australia Ltd.
The e cacy of taking statins
preoperatively for patients
undergoing heart surgery
By Hanan Khalil
Dr Hanan Khalil is the Director of the
Centre for Chronic Disease Management,
a collaborating centre of the Joanna
Briggs Institute, Faculty of Medicine,
Nursing and Health Sciences, Monash
University, and a reviewer for the
consumer group of the Cochrane
The purpose of this evidence summary is
to provide the best available information
on the e cacy of statins preoperatively
on patients undergoing heart surgery.
For the full Cochrane review, please refer
to: Liakopoulos OJ, Kuhn EW, Slottosch
I, et al. Preoperative statin therapy for
patients undergoing cardiac surgery.
Cochrane Database of Systematic Reviews
2012, Issue 4. Art. No.: CD008493. DOI:
Patients undertaking cardiac surgery are
at a signi cant risk of developing serious
cardiovascular adverse events due to
surgery, existent co-morbidities and
increasing age.2 The rate of major adverse
events increased substantially from ve
to 15% in recent years. Implementing
strategies to reduce adverse events in this
group of patients will greatly enhance
their recovery from surgery.3
HMG-coA reductase inhibitors have
been shown to successfully reduce the
risk of atherosclerosis associated with
cardiac diseases by their lipid lowering
e ect. The overall bene ts observed
with statins appear to be greater than
what was expected from changes in
lipid levels alone, suggesting additional
e ects beyond cholesterol lowering.
Recent studies indicate that some
of the cholesterol-independent or
'pleiotropic' e ects of statins involve
improving endothelial function,
enhancing the stability of atherosclerotic
plaques, decreasing oxidative stress
and in ammation and inhibiting the
The above mentioned systematic
review provides data to enable
recommendations of statins
preoperatively in patients undergoing
cardiac surgery (CABG procedures).
Characteristics of the studies
The studies selected for the systematic
review were randomised clinical trials
comparing any statin treatment before
cardiac surgery (CABG procedures) for any
period of time and dose to the following
• no pre-operative statin therapy
• co-interventions were allowed
provided all arms of the randomised
allocations received the same
Quality of the research
There was a low risk of bias except for
random sequence generation allocation
(<45% of the included trials) and lack of
allocation concealment (<20% of studies).
Blinding was adequately addressed
in nine out of the 11 studies included.
Only one study out of 11 was judged to
be a ected by selective reporting.
• Several databases such as the Cochrane
Central register of Controlled Trials
(CENTRAL), Medline and Embase
• Eleven trials with a total of 984
participants met the inclusion criteria
and were included in the review with
participants' age ranging between
56 and 76 years of age.
• The number of patients in each trial
ranged from 20 to 200.
• In most of the studies, statin treatment
consisted of atorvastatin in six studies
and simvastatin was used in two
studies. Fluvastatin, rosuvastatin and
pravastatin were also used in the other
• The duration of pre-operative intake of
statin varied from the evening before
surgery to four weeks before the
operation. Only three studies reported
on the re-initiation of statin therapy
• The primary outcome measure was
short term post-operative mortality
(i.e. in-hospital or 30-day mortality).
• Other outcome measures reported
include the incidence of developing
atrial brillation (AF), myocardial
infarction (MI), stroke, length of stay
in hospital, length of stay in ICU and
• Pre-operative statin therapy was
associated with a signi cant reduction
for the odds of AF after cardiac surgery,
suggesting a bene cial e ect for a
pre-operative statin treatment when
compared to control.
• Patients with a pre-operative statin
medication had a signi cantly reduced
length of stay in ICU and in hospital
when compared to the control group.
• Pooled analysis of the MI and renal
failure showed a bene cial e ect in
favour of the intervention group but
lacked statistical signi cance.
• There was no di erence in treatment
e ects observed with regard to
post-operative short-term mortality
• Adverse events were only reported in
Implications for research and
The results obtained from this review
highlighted the bene cial e ect of
pre-operative statin therapy in patients
undergoing routine CABG procedures.
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