Effect of statin drugs on thoracic aortic aneurysms.
Pharmacologic interventions for thoracic aneurysms remain poorly characterized. The results of a pilot study by our group suggested improved outcomes among patients with thoracic aortic aneurysm who were taking statins. In the present study, we undertook a comprehensive analysis of a larger cohort of patients from the Database of the Aortic Institute at Yale-New Haven Hospital. A total of 1,560 patients met the inclusion criteria. The adverse events (i.e., death, dissection, or rupture) and surgery rates for patients with (n = 369, 24%) and without (n = 1,191, 76%) statin therapy were compared. We evaluated 3 anatomic components of the aorta: root, ascending and arch, and descending and thoracoabdominal aortic aneurysms. A smaller proportion of the statin group had adverse events: overall, 7% versus 15%; ascending and arch, 6% versus 15%; and descending and thoracoabdominal aortic aneurysms, 8% versus 20%. Also, a smaller proportion of statin patients required surgery: overall, 48% versus 60%; ascending and arch, 51% versus 62%; and descending and thoracoabdominal aortic aneurysms, 36% versus 59% (p <0.001 to 0.01). The protective effect of statins was seen in all segments, except the aortic root. Log-rank evaluation of the interval to an adverse event or surgery was longer among statin-treated patients (p <0.001). Logistic regression analysis found statin use, angiotensin receptor blocker use, and chronic obstructive pulmonary disease were associated with decreased adverse events, and statin use, angiotensin receptor blocker use, β-blocker therapy, and age were associated with a decreased odds of requiring surgery. Multiple logistic regression analysis found only statins were associated with a decreased odds of an adverse event and that statins, coronary artery disease, and chronic obstructive pulmonary disease were associated with a decreased odds of undergoing surgery. In conclusion, these findings provide a medicinal option for the arsenal of treatment options for patients with aneurysms of the thoracic aorta.
Aortic Institute, Yale-New Haven Hospital, New Haven, Connecticut.
Louis H
LH
Stein
Jessica
J
Berger
Maryann
M
Tranquilli
John A
JA
Elefteraides
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000401:mortality
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors