Association of ambulatory use of statins and beta-blockers with long-term mortality after vascular surgery.
BACKGROUND
The use of drugs to improve postoperative outcomes has focused on short-term end points and centered on beta-blockers. Emerging evidence suggests statins may also improve postoperative outcomes.


OBJECTIVE
We sought to ascertain if the ambulatory use of statins and/or beta-blockers was associated with a reduction in long-term mortality after vascular surgery.


METHODS
Retrospective cohort study with a median follow-up of 2.7 years.


METHODS
Regional multicenter study at Veterans Affairs medical centers.


METHODS
Three thousand and sixty-two patients presenting for vascular surgery.


METHODS
Patients were categorized as using statins or beta-blockers if they filled a prescription for the study drug within 30 days of surgery. Survival analyses, propensity score methods, and stratifications by the revised cardiac risk index (RCRI) were performed.


RESULTS
Propensity-adjusted ambulatory use of statins and beta-blockers was associated with a reduction in mortality over the study period compared with nonuse of these medications hazard ratio [HR] = 0.78 [95% CI: 0.67-0.92], P = .0021, and number needed to treat (NNT) = 22 for statins; HR = 0.84 [95% CI: 0.73-0.96], P = .0106, and NNT = 30 for beta-blockers. In addition, for propensity-adjusted use of both statins and beta-blockers compared with neither the HR was 0.56 [95% CI: 0.42-0.74] P < .0001, and NNT was 9. The RCRI confirmed combination statin and beta-blocker use was beneficial at all levels of risk. Use of the combination study drugs by the highest-risk patients was associated with a 33% decrease in mortality after 2 years (P = .0106).


CONCLUSIONS
The use of ambulatory statins alone or in combination with beta-blockers is associated with a reduction in long-term mortality after vascular surgery, and combination use benefits patients at all levels of risk.
Barrett
Thomas W
TW
Portland Veterans Affairs Medical Center, Section of General Medicine, Portland, Oregon 97207-1034, USA. barretth@ohsu.edu
Mori
Motomi
M
De Boer
David
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000553:Ambulatory Care; D016009:Chi-Square Distribution; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality*
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors