Reduction in cardiovascular events after vascular surgery with atorvastatin: A randomized trial

Impact of combination medical therapy on mortality in vascular surgery patients

“…Aspirin has been associated with decreased mortality in patients undergoing coronary artery bypass graft surgery, 25 but the effects of aspirin on noncardiac surgery outcomes is less clear. 26 Beta-blockers and statins have been associated with decreased short-term and long-term mortality after vascular surgery in the past, [8][9][10][11][12][13][14] but more recent beta-blocker studies have been negative, introducing controversy for the topic. [15][16][17]27 Beta-blockers are currently recommended as: Class I (should be used), Evidence Level B (limited Association (ACC/AHA) guidelines for perioperative evaluation.…”

“…Perioperative ischemia is associated with a 9-fold increase in the odds of unstable angina, nonfatal myocardial infarction, and cardiac death, while a perioperative myocardial infarction increases the odds of death 20-fold up to 2 years after surgery. [5][6][7] Prior research has centered on the single or combination use of perioperative beta-blockers and statins, which has been associated with decreased short-term and long-term mortality after vascular surgery, [8][9][10][11][12][13][14] with the exceptions of the Metoprolol After Vascular Surgery (MAVS) 15 and the Perioperative Beta-Blockade (POBBLE) studies, 16 which were negative beta-blocker randomized controlled trials exclusively in vascular surgery patients, and the Perioperative Ischemic Evaluation (POISE) study, 17 which was the largest perioperative beta-blocker trial to date in noncardiac surgery, with 41% of the patients undergoing vascular surgery.…”

Perioperative myocardial infarction in non-cardiac surgery. Pathophysiology and clinical implications

“…For these patients undergoing non-cardiac procedures including major vascular surgery, a combination of betablockers with statins may offer additional prevention [83][84][85] .…”

2014 ESC/ESA Guidelines on Non-cardiac Surgery: Cardiovascular Assessment and Management

“…107 -110 In a prospective, randomized, controlled trial, 100 patients scheduled for vascular surgery were allocated to 20 mg of either atorvastatin or placebo once daily for 45 days, irrespective of their serum cholesterol concentrations. 111 At 6-month follow-up, atorvastatin significantly reduced the incidence of cardiac events (8% vs. 26%; P ¼ 0.03). In patients in whom statins were introduced before intervention, two meta-analyses showed a significant reduction in the risk of post-operative myocardial infarction following invasive procedures, 112,113 however, these meta-analyses included more clinical trials relating to cardiac surgery or percutaneous procedures than to non-cardiac surgery.…”