statins after bypass surgery

Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE). Beyond the intermediate and long-term benefits of statin therapy, he added, a number of studies have suggested there may be additional benefits of starting or continuing statin therapy after bypass surgery. We also performed an analysis whereby patients who required long-term care after surgery (rehabilitation or nursing home) were removed from the cohort. Side Effects of Cholesterol-Lowering Statin Drugs, When Statins Don’t Work: Tests for Your High Cholesterol, Beyond Statins: Other Medicines for High Cholesterol. Elgendy recommends that patients start taking a statin before bypass surgery if they are not taking one, and continue taking a statin if they are already doing so. In contrast to the patients enrolled in the Post-CABG Trial, CABG patients in the current era are older, have more coexisting conditions, and are increasingly likely to be female.10 Moreover, the Post-CABG Trial enrolled patients several years after they had undergone surgery (55% of patients had undergone surgery >5 years previously), with saphenous vein graft atherosclerosis likely already in progress.7 Whether postoperative outcomes are improved by the administration of statins in the early months after coronary surgery has not been investigated specifically. The mean age of the cohort was 75.6±5.4 years, and 65.0% of the patients were women. So called high-intensity statins – 40 to 80 milligrams of atorvastatin or 20 to 40 milligrams of rosuvastatin – are the current standard of care … We classified the “operating surgeon” as the cardiac, cardiothoracic, or thoracic surgeon who submitted a claim for CABG on the date of surgery using Medicare Part B claims. Take all prescribed medications as directed. Data sources: A MEDLINE search was performed (1950-October 2007) using the search terms statins, HMG-CoA reductase inhibitors, coronary artery bypass graft, cardiac surgery, and atrial fibrillation. On univariate analysis, freedom from MACE was significantly better among patients who received postoperative statins within 1 month of surgery discharge (HR 0.88, 95% CI 0.81 to 0.95). Coronary artery bypass graft surgery (CABG) is an effective treatment for ischemic heart disease; however, the long-term results after CABG are compromised by the progression of atherosclerosis in native coronary arteries and saphenous vein bypass grafts.1,2 Only 60% of vein grafts remain patent 10 years after surgery, and 50% of those that are patent have clinically important stenosis.1,2 As a result, patients are at high risk for subsequent ischemic events after CABG, including death, myocardial infarction, and stroke.1,2, Strong evidence is available to support the use of statins to reduce the risk of recurrent cardiovascular events and improve survival in patients with native coronary artery disease3; however, less is known about the benefits of statins after CABG. As with all medications, the exact doses, timing, and combinations are important. Freedom from MACE after CABG, stratified by statin use within 1 month of surgery discharge. Initially I didn't experience any side-effects but by the 6 month I began to experience severe rotator cuff pain and immobility. Guest Editor for this article was Donald D. Heistad, MD. Hazard ratios (HRs) are reported along with SEs or 95% confidence intervals (CIs). I had a quad-bypass surgery on 10/30/14. 1,2,16 For many years, statins were administered after CABG to reduce low-density lipoprotein levels to <100 mg/dL. In the multivariable analysis, postoperative statin use within 1 month of surgery discharge was independently associated with better freedom from MACE (HR 0.89, 95% CI 0.81 to 0.98). Similarly, statin use within 1 month of CABG discharge independently reduced the risk of major adverse cardiovascular events (adjusted hazard ratio 0.89, 95% confidence interval 0.81 to 0.98). With removal from the analyses of those patients who were discharged to long-term care facilities after CABG (n=2076), postoperative statin use within 1 month of surgery discharge was associated with nonsignificant trends toward better freedom from all-cause mortality (adjusted HR 0.87, 95% CI 0.75 to 1.02) and better freedom from MACE (adjusted HR 0.92, 95% CI 0.82 to 1.03). Statins have been used in an increasing number and variety of conditions. This may be related to the development of saphenous vein graft atherosclerosis and occlusion, a process that, although slowed by statin therapy,7–9 typically manifests clinically 5 to 10 years after CABG.1,2, Several investigators have previously demonstrated that preoperative statin therapy improves clinical outcomes after CABG, including a reduced risk of death, myocardial infarction, and arrhythmias in the first 60 days after surgery.21–24 With a focus on preoperative statin use, none of these studies specifically assessed the use of statins after surgery. *Models stratified by preoperative statin use. Postoperative ACE inhibitor or angiotensin II receptor blocker, *Intention-to-treat analysis with censoring at the time of outcome or at the end of follow-up (as in. Data synthesis: POAF is a common complication following CABG surgery that is associated with significant morbidity. In addition, statins also reduced the risk of dying in the hospital after the operation by 43 percent. Association between statins and infections after coronary artery bypass grafting ... C.D. We assembled the present cohort by linking Medicare files to data from the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) and the New Jersey Pharmaceutical Assistance to the Aged and Disabled (PAAD) programs. In the only randomized controlled trial to evaluate the long-term use of β-blocker therapy after CABG, the MACB (Metoprolol After Coronary Bypass) study demonstrated that 100 mg of metoprolol twice per day for 2 years after surgery did not reduce the incidence of repeat revascularization, unstable angina, nonfatal myocardial infarction, or death compared with placebo.26 Two randomized, controlled trials have studied the use of ACE inhibitors after CABG. The current clinical guidelines recommend cholesterol treatment to achieve low-density lipoprotein levels <100 mg/dL for all patients after CABG.4–6,14 These recommendations are based primarily on studies published more than 10 years ago that enrolled low-risk patients several years after surgical coronary revascularization.7,15 Whether these data are applicable to representative patients who currently present for CABG has not been evaluated recently. Request an Appointment at Mayo Clinic. statinfreeremedy. Which Drugs Lower My Bad (LDL) Cholesterol? These recommendations are based primarily on the results of the Post-CABG Trial, a study that evaluated aggressive cholesterol treatment with lovastatin 40 mg/d compared with moderate cholesterol treatment with lovastatin 5 mg/d. But while the researchers found statins were well-tolerated by patients before bypass surgery, they also found they are vastly underused. After having heart bypass surgery, a person will most likely need to take aspirin every day for the rest of their life. Common medications after bypass surgery include drugs for pain management, lower cholesterol and blood pressure, potential blood clots, diabetes and depression. Table 1 describes the characteristics of the patients who did (n=1745) and did not (n=5788) fill prescriptions for statins within 1 month of CABG discharge. Although a significant interaction was found between time and statin use in this model (P=0.02), the interval-specific HRs were virtually identical (ie, <0.001 absolute difference in HRs over a 5-year interval), and therefore, no meaningful violation of the proportional hazards assumption occurred. We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE). We performed a meta-analysis of 12 studies that compared statins with controls. Aug. 16 -- FRIDAY, Aug. 15 (HealthDay News) -- Statins reduce the perils facing obese people after they have the bypass surgery that restores blood flow to an endangered heart, a study finds. Overall, 2324 patients died in the present study cohort, and 3686 patients developed MACE. Taking statins prior to CABG surgery can help protect people against developing atrial fibrillation, an irregular heartbeat that is a common complication following heart surgery. The goal of this study will be to see if high-dose statin therapy will prevent the development of vein graft occlusion during the first year after bypass surgery. The QUO VADIS (Quinapril on Clinical Outcome After Coronary Artery Bypass Grafting) study of 149 patients documented a reduction in the composite outcome of angina, death, myocardial infarction, repeat revascularization, stroke, or transient ischemic attacks in patients who received quinapril for 1 year after CABG compared with placebo (3.5% versus 15%, quinapril versus placebo, P=0.02).27 However, these findings were not confirmed in the larger multicenter IMAGINE (Ischemia Management with Accupril post bypass Graft via Inhibition of angiotensin coNverting Enzyme) trial of 2204 patients, which showed quinapril to have no benefit compared with placebo when administered after CABG.28,29. Recently, a study showed that taking a statin drug after CABG may reduce this risk. MACE was defined as hospital admission for myocardial infarction or unstable angina, stroke, coronary artery revascularization (redo CABG or percutaneous coronary intervention), or out-of-hospital coronary death (death outside of the hospital without previous diagnosis of cancer [International Classification of Diseases, 9th Revision code 140.X to 208.X] or human immunodeficiency virus [International Classification of Diseases, 9th Revision code 042] within 1 month of death). All rights reserved. Among patients who undergo lower extremity bypass surgery for severe PAD, small trials and observational data sets suggest that statin therapy may have protective effects on bypass graft patency and on patient survival.9, 10, 11 However, these studies only ascertained statin use at the time of surgery and were restricted in size and generalizability. Finally, the present study is limited by the lack of power to fully assess the impact of initiating statins early after surgery (within 1 month of CABG discharge) compared with delayed administration (1 to 6 months after discharge). Studies have shown that quitting smoking after bypass surgery significantly reduces your risk of having a second bypass operation. Table 3. Discontinuing statin drugs after bypass surgery - Heart bypass surgery. If 2 or more surgeons were identified for an individual patient, then we defined the most responsible surgeon as the surgeon who submitted the most claims for that specific patient after surgery. use prohibited. Methods: Phase 3, uni-centric, randomized clinical trial, with intention-to-treat analysis to compare LDL cholesterol remission between gastric bypass and sleeve gastrectomy with a 12 months follow-up. Table 2. These results support existing practice guidelines and confirm that in the absence of serious contraindications, essentially all patients should be prescribed long-term statin therapy after CABG. Studies have shown that quitting smoking after bypass surgery significantly reduces your risk of having a second bypass operation. Our aim was to evaluate the changes of cholesterol metabolism induced by malabsorptive and restrictive surgery independent of weight loss. By continuing to browse this site you are agreeing to our use of cookies. Preoperative statin associated with a reduced risk of atrial fibrillation after coronary artery bypass surgery. Go to http://cme.ahajournals.org to take the CME quiz for this article. CollardStatins are associated with a reduced incidence of perioperative mortality after coronary artery bypass graft surgery. 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