Statin therapy improved long-term prognosis in patients with major non-cardiac vascular surgeries: a systematic review and meta-analysis

Yu, Wenpei; Wang, Bin; Zhan, Bin; Li, Qiang; Li, Yingsha; Zhu, Zhiming; Yan, Zhencheng

doi:10.1016/j.vph.2018.06.015

Cited by 7 publications

(5 citation statements)

References 82 publications

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“…That meta-analysis described also a lower incidence of periprocedural stroke as a result of statin administration. Lastly, a similar meta-analysis (four studies of 4 978 patients) showed better survival rates and decreased risk of stroke when statins were used before CEA [89]. In conclusion, in patients undergoing CEA, the early prescription of statins unambiguously reduces mortality and, possibly, stroke incidence, but more studies are needed.…”

Section: Perioperative Treatment With Statins Of Patients With Caroti...mentioning

confidence: 83%

A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review

et al. 2022

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Novel imaging techniques and biomarkers have emerged as surrogate markers of carotid plaque vulnerability. In parallel, statin administration in patients with established carotid atherosclerosis not requiring revascularization has reduced the number of consequent cerebrovascular events. This reduction is not only attributed to the lipid-lowering properties of statins but also to their pleiotropic actions. The present literature review aimed to summarize the stabilizing effects of statins on carotid plaques based on imaging modalities and biomarkers and propose an alternative approach to their implementation. Moreover, we assessed the perioperative use of statins in patients undergoing carotid revascularization and the impact of aggressive vs. conventional statin therapy. Recent studies using: (1) ultrasound indices of plaque echogenicity; (2) fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) scans for plaque inflammation assessment; or (3) magnetic resonance imaging (MRI) scans quantifying intraplaque hemorrhage, and lipid-rich necrotic core (LRNC) have shown quite promising results in evaluation of carotid plaque vulnerability. Based on those imaging modalities, a growing number of studies have demonstrated a very modest carotid plaque regression due to/induced by statins, while their stabilizing impact is disproportionally higher. Other studies assaying several biomarkers (e.g. inflammation, etc.) have confirmed a statin-induced carotid plaque stabilization. All the aforementioned benefits followed a dose-dependent pattern of statins, on top of the low-density lipoprotein cholesterol (LDL-C) target in current guidelines. In the case of symptomatic patients with carotid atherosclerosis suitable for revascularization, robust evidence implicates a significant statin-related reduction of perioperative cardiovascular risk only in patients undergoing endarterectomy.

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Section: Perioperative Treatment With Statins Of Patients With Caroti...mentioning

confidence: 83%

A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review

et al. 2022

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“…The positive effect of statins regarding mortality, MACCE, and amputation was shown even in vulnerable patients with critical limb ischemia 54 . Treatment with statins also significantly improves outcome regarding survival and patency rates in patients after noncardiac vascular surgery 55 and peripheral intervention 56 . Besides statins, also PCSK9 inhibition showed a positive effect on amputation‐free survival of patients with critical limb inschemia 57 .…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany

Schmitt

Hobohm

Vosseler

et al. 2022

Journal of Diabetes

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Introduction In patients with peripheral artery disease (PAD) the presence of diabetes mellitus (DM) is associated with higher morbidity and mortality. Because huge efforts are made to improve medical care of patients with DM including chronic disease programs, the aim of the present study was to investigate temporal trends regarding the clinical burden of DM on PAD patients within a 15‐year observational period. Methods We analyzed all patients hospitalized because of PAD between 2005 and 2019 in Germany stratified regarding DM. Results Overall, 2 654 871 hospitalizations of PAD patients (865 823 with DM) were included. Hospitalizations based on PAD inclined from 142 778 in 2005 to 190 135 in 2019 ( β 3956 per year; 95% confidence interval [CI] 3034–4878, p < .001) with simultaneous increase of hospitalizations of PAD patients with DM (2005: 41609 (29.1%) versus 2019: 65 302 (34.3%); β 2019 per year [95% CI 1593–2446], p < .001). Amputation rates ( β −0.42 [95% CI −0.44 to −0.40]; p < .001) as well as in‐hospital case‐fatality rate (2005: 4.7%, 2019: 2.8%; β −0.64 [95% CI −0.69 to −0.59]; p < .001) decreased in diabetic PAD patients during the observational time. In spite of improved morbidity and mortality in the last years of the observational period, patients with DM still suffered from an increased risk for morbidity and mortality during the observational period compared to nondiabetic PAD patients. Conclusions Despite the progress in DM treatments, DM still was associated with an unfavorable clinical patient profile and remained a substantial risk factor for morbidity and mortality in hospitalized patients with PAD and DM in Germany between 2005 and 2019.

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“…The protective effect of statins on the onset of peri-procedural complications and long-term cardiovascular events and mortality after angioplasty and stenting has been demonstrated in coronary and other arterial sites [ 4 , 20 ], as well as in carotid surgical endarterectomy [ 21 ]. Previous studies have extended this evidence also in carotid artery stenosis regarding peri-procedural complications [ 6 , 11 , 13 ] and 5-years mortality [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…Statins reduce total and LDL-cholesterol levels that are implicated in the development and progression of atherosclerotic arterial lesions with an effect that is wider than effects related just to LDL-cholesterol reduction [ 2 ]. Although evidence of the protective effects of statins in cardiac and extra-cardiac revascularization is recognized [ 3 , 4 ], benefit of statins use in the prevention of major adverse cardiovascular events (MACE) and long-term mortality after CAS has been suggested in a single observational study [ 5 ]. In this multicenter Italian study, more than 1000 patients were recruited after primary CAS, and statins were taken by 43% of patients before the procedure.…”

Section: Introductionmentioning

confidence: 99%

Pre-Procedural Statin Use Is Associated with Improved Long-Term Survival and Reduced Major Cardiovascular Events in Patients Undergoing Carotid Artery Stenting: A Retrospective Study

Colussi

Zuttion

Bais

et al. 2018

JCM

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Carotid artery stenting (CAS) is a minimal invasive procedure used to resolve carotid occlusion that can be affected by peri-procedural complications. Statin use before CAS has shown to reduce peri-procedural risk and improve survival, though time-dependent cofactors that influence mortality has not been considered. The aim of this study was to evaluate long-term survival of patients who undergo CAS considering new occurred major adverse cardiovascular event (MACE) as time-dependent cofactor. In this study, 171 high cardiovascular risk patients (age 72 ± 8 years, 125 males) were enrolled after CAS procedure and were followed for a median of 8.4 years. Death occurred in 44% of patients with a mean time to death of 69 ± 39 months and MACE in 34% with a mean time of 35 ± 42 months. In patients who used or not statins at baseline, death occurred in 33% and 65%, respectively (p < 0.001). Survival analysis showed that statin use reduced risk of death (hazard ratio HR 0.36, 95% confidence interval CI 0.23–0.58, p < 0.0001). Including MACE as time-dependent variable did not change beneficial effects of statins. Additionally, statin use was associated with a protective effect on MACE (HR 0.48, 95% CI 0.27–0.85, p = 0.012); particularly, the prevalence of stroke was reduced by 59% (p = 0.018). In multivariate analysis, effects of statins were independent of demographic and anthropometric variables, prevalence of cardiovascular risk factors, renal function, antiplatelet use, and MACE occurrence. In conclusion, use of statins before CAS procedure is associated with increased long-term survival and reduced MACE occurrence. This evidence supports the hypothesis that statin use before CAS might be beneficial in high risk patients.

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Statin therapy improved long-term prognosis in patients with major non-cardiac vascular surgeries: a systematic review and meta-analysis

Cited by 7 publications

References 82 publications

A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review

A new approach of statin therapy in carotid atherosclerosis: Targeting indices of plaque vulnerability on the top of lipid-lowering. A narrative review

Temporal trends in patients with peripheral artery disease influenced by diabetes mellitus in Germany

Pre-Procedural Statin Use Is Associated with Improved Long-Term Survival and Reduced Major Cardiovascular Events in Patients Undergoing Carotid Artery Stenting: A Retrospective Study

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