Cholesterol Drugs May Cut Death Risk After Surgery

NEW YORK (Reuters Health) - Treatment with cholesterol-lowering agents,
particularly "statin" drugs like Lipitor or Zocor, may reduce the risk of
death after major surgery, new research suggests.

In a study reported in the Journal of the American Medical Association,
patients who used such agents on at least the first or second hospital day
were 38 percent less likely to die while hospitalized than patients who
didn't take the drugs.

"Beta-blocker" drugs, such as Tenormin or Toprol, "have been shown to
benefit patients when given around the time of surgery," lead author Dr.
Peter K. Lindenauer, from Baystate Medical Center in Springfield,
Massachusetts, told Reuters Health. "But such therapy doesn't completely
eliminate the risk of postoperative complications," so there's still a need
for other therapies that can improve outcomes.

"Statins have been shown to have a number of effects that may help stabilize
(blood vessel) plaques," Lindenauer noted. "Since rupture of such plaques is
thought to be responsible" for most postoperative heart attacks and other
adverse events, he added, it seemed logical to look at the effect of
cholesterol drugs on the death risk after surgery.

The results are based on a study of more than 780,000 patients who underwent
major surgery in the US during 2000 and 2001. The operations included a
variety of general, gynecologic, and specialist procedures. Patients who
used cholesterol drugs on the first or second hospital day were classified
as users.

Overall, 3 percent of patients died during hospitalization, the authors
report. The mortality rate for patients treated with cholesterol drugs was
2.2 percent, significantly lower than the 3.2 percent rate seen for
nonusers. The reduction in mortality was more pronounced with statins than
with other cholesterol drugs.

So, should every patient undergoing major surgery now receive cholesterol
drugs? Lindenauer believes that it is too early to make this conclusion.
"Our study was observational and I think the findings really need to be
confirmed" in a trial designed to specifically answer that question.

One of the key issues that needs to be addressed, according to Lindenauer,
is the timing and duration of therapy needed to produce a benefit. In the
present study, these parameters could not be evaluated.

SOURCE: Journal of the American Medical Association, May 5, 2004.

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