title: Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study.
abstract: OBJECTIVE
  We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery.
  
  
  BACKGROUND
  Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter.
  
  
  METHODS
  A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect.
  
  
  RESULTS
  Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p = 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p = 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins.
  
  
  CONCLUSIONS
  Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
authors.forename: Kristin
authors.initials: K
authors.lastname: O'Neil-Callahan
authors.forename: George
authors.initials: G
authors.lastname: Katsimaglis
authors.forename: Micah R
authors.initials: MR
authors.lastname: Tepper
authors.forename: Jason
authors.initials: J
authors.lastname: Ryan
authors.forename: Carla
authors.initials: C
authors.lastname: Mosby
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
authors.forename: Peter G
authors.initials: PG
authors.lastname: Danias
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016017:Odds Ratio; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors