Association of Perioperative Statins and Beta‐Blockers with Long Term Mortality After Vascular Surgery

Background:

The use of perioperative beta‐blockers improves outcomes after surgery. Recent studies have shown promising preliminary results suggesting perioperative statins may also benefit patients. We sought to ascertain if the use of these drugs was associated with a reduction in mortality after surgery.

Method:

We conducted a retrospective cohort study of patients presenting for vascular surgery between January 1998 and March 2005. The patients were identified using a regional Department of Veterans Affairs database. 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 (Kaplan‐Meier method, logrank test, Cox regression method) were performed. Patients were censored five years after surgery. Propensity score methods were used to evaluate the effects of medication on overall survival.

Summary of Results:

There were 3,062 patients with an overall mean follow up of 2.7 years. The use of statins and beta‐blockers were associated with a reduction in mortality over the study period, compared to non‐users, unadjusted HR 0.66, (95%CI 0.58‐0.75), p < 0.0001 and HR 0.74, (95%CI 0.66‐0.84), p < 0.0001, respectively. The protective effects of statins and beta‐blockers remained after adjusting for the propensity scores, HR 0.80 for statin, (95%CI 0.69‐0.94), p = 0.005, and HR 0.84 for beta‐blocker, (95%CI 0.73‐0.96), p = 0.010. In addition, stratifying patients based on both statin and beta‐blocker use into stain only, beta‐blocker only, and both, compared to neither demonstrated an association with decreased mortality at 6 months, 1 year, and 2 years after surgery (Table 1). The revised cardiac risk score (RCRS) was also used to stratify these patients. Using a statin or beta‐blocker was equivalent to using both for patients with a RCRS of 3 or greater, but using both drugs provided an additive benefit for patients with a RCRS of 2 or less. The use of a statin, beta‐blocker, or both was associated with a decrease in mortality for all levels of risk.

Statement of Conclusions:

Perioperative statins used alone or in combination with beta‐blockers are associated with a reduction in long term mortality after vascular surgery and benefit patients at all levels of risk.

Author Disclosure Block:

T.W. Barrett, None; M. Mori, None; D. De Boer, None.