title: Beta-blockers and statins are individually associated with reduced mortality in patients undergoing noncardiac, nonvascular surgery.
abstract: BACKGROUND
  Patients undergoing noncardiac, nonvascular surgery are at risk for perioperative mortality owing to underlying (a)symptomatic coronary artery disease. We hypothesized that beta-blocker and statin use are associated with reduced perioperative mortality.
  
  
  METHODS
  We performed a case-control study in 75 581 patients who underwent 108 593 noncardiac, nonvascular surgery at the Erasmus Medical Center between 1991 and 2001. Cases were the 989 patients who died during hospital stay after surgery. From the remaining patients, 1879 matched controls (age, sex, calendar year and type of surgery) were selected. Information was then obtained regarding the use of beta-blockers and statins and the presence of cardiac risk factors.
  
  
  RESULTS
  The median age of the study population was 63 years; 61% were men. beta-blockers were less often used in cases than in controls (6.2 vs. 8.2%; P=0.05), as were statins (2.4 vs. 5.5%; P<0.001). After adjustment for the propensity of beta-blocker use and cardiovascular risk factors, beta-blockers were associated with a 59% mortality reduction (odds ratio 0.41; 95% confidence interval 0.28-0.59). Statins were associated with a 60% mortality reduction (adjusted odds ratio 0.40; 95% confidence interval 0.24-0.68). A significant interaction between beta-blockers and statins was observed (P<0.001). In the presence of each other, statins and beta-blockers were not associated with reduced mortality (adjusted odds ratio 2.0 and 95% confidence interval 0.74-5.7 and adjusted odds ratio 1.3 and 95% confidence interval 0.52-3.2). It should be, however, noted that only nine cases and 29 controls used both agents simultaneously.
  
  
  CONCLUSIONS
  This case-control study provides evidence that beta-blockers and statins are individually associated with a reduction of perioperative mortality in patients undergoing noncardiac, nonvascular surgery.
authors.affiliation: Departments of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Noordzij
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Frodo
authors.initials: F
authors.lastname: Schreiner
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Martin
authors.initials: M
authors.lastname: Dunkelgrun
authors.forename: Miklos D
authors.initials: MD
authors.lastname: Kertai
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology*; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D013514:Surgical Procedures, Operative / Q000401:mortality*
chemical_list: D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors