The effect of statins on perioperative inflammation in cardiac and thoracic surgery

Sodha, Neel R.; Sellke, Frank W.

doi:10.1016/j.jtcvs.2015.02.005

Cited by 12 publications

(10 citation statements)

References 40 publications

(38 reference statements)

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“…Statins are the most commonly prescribed medications to treat cardiovascular disease with its lipid‐lowering effects . In addition to inhibiting lipid synthesis, statins are likely to play an important role in the modulation of inflammatory response . Statins have been shown to decrease endothelial permeability and lung inflammation in animal models of lung injury .…”

Section: Discussionmentioning

confidence: 99%

Statins for the prevention and treatment of acute lung injury and acute respiratory distress syndrome: A systematic review and meta‐analysis

et al. 2016

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The purpose of this meta-analysis was to assess whether statins could reduce the morbidity of acute lung injury and acute respiratory distress syndrome (ALI/ARDS) in high-risk patients and improve the clinical outcomes of patients with ALI/ARDS. Studies were obtained from PubMed, Medline, Embase and Cochrane Central Register of Controlled Trials. Randomized controlled trials (RCTs) and cohort studies, which reported morbidity, mortality, ventilator-free days, length of stay in intensive care unit and hospital or oxygenation index, were included in our meta-analysis. Risk ratio (RR) and weighted mean difference (WMD) were calculated using fixed or random effect model. A total of 13 studies covering 12 145 patients were included. Both the only RCT (P = 0.10) and cohort studies (RR, 1.02; 95% CI, 0.67 to 1.55; P = 0.94) showed that statin therapy did not lower the morbidity of ALI/ARDS in high-risk patients. The mortality of ALI/ARDS patients was less likely to be improved by statins (RCT, RR, 1.00; 95% CI, 0.84 to 1.20; P = 0.97; cohort studies, RR, 1.04; 95% CI, 0.85 to 1.27; P = 0.72). Moreover, no significant difference was observed in ventilator-free days, length of stay in intensive care unit as well as hospital and oxygenation index. This meta-analysis suggests that statins neither provide benefit for lowering the morbidity of ALI/ARDS in high-risk patients nor improve the clinical outcomes of ALI/ARDS patients. Hence, it may not be appropriate to advocate statin use for the prevention and treatment of ALI/ARDS.

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Section: Discussionmentioning

confidence: 99%

Statins for the prevention and treatment of acute lung injury and acute respiratory distress syndrome: A systematic review and meta‐analysis

et al. 2016

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“…Moreover, knowledge of pleiotropic anti-inflammatory effects of statins [11, 12] has led to consider statins a potential therapy able to modulate the inflammatory response to cardiac surgery. In support of this assumption, several randomized controlled trials (RCTs), reporting on inflammatory markers and statin use in perioperative cardiac surgery, have demonstrated reduction in inflammatory cytokines [12].…”

Section: Introductionmentioning

confidence: 99%

“…In support of this assumption, several randomized controlled trials (RCTs), reporting on inflammatory markers and statin use in perioperative cardiac surgery, have demonstrated reduction in inflammatory cytokines [12]. In several retrospective non-randomized studies, preoperative statins have been associated with lower postoperative MI, mortality [13–17], AF [17, 18], neurological dysfunction [16], renal dysfunction [19], and infection [20].…”

Section: Introductionmentioning

confidence: 99%

Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials

et al. 2016

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BackgroundSeveral studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials (RCTs) show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients.MethodsElectronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery. Postoperative outcomes were acute kidney injury, atrial fibrillation, myocardial infarction, stroke, infections, and mortality. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using fixed-effects meta-analyses. Primary analysis was restricted to trials with low risk of bias according to Cochrane methodology, and sensitivity analyses examined whether the risk of bias of included studies was associated with different results. We performed trial sequential analysis (TSA) to test the strength of the results.ResultsWe included data from 23 RCTs involving 5102 patients. Meta-analysis of trials with low risk of bias showed that statin therapy was associated with an increase in acute kidney injury (314 of 1318 (23.82%) with statins versus 262 of 1319 (19.86%) with placebo; OR 1.26 (95%CI 1.05 to 1.52); p = 0.01); these results were supported by TSA. No difference in postoperative atrial fibrillation, myocardial infarction, stroke, infections, or mortality was present. On sensitivity analysis, statin therapy was associated with a slight increase in hospital mortality. Meta-analysis including also trials with high or unclear risk of bias showed no beneficial effects of statin therapy on any postoperative outcomes.ConclusionsThere is no evidence that statin therapy in the days prior to cardiac surgery is beneficial for patients’ outcomes. Particularly, statins are not protective against postoperative atrial fibrillation, myocardial infarction, stroke, or infections. Statins are associated with a possible increased risk of acute kidney injury and a detrimental effect on hospital survival could not be excluded. Future RCTs should further evaluate the safety profile of this therapy in relation to patients’ outcomes and assess the more appropriate time point for discontinuation of statins before cardiac surgery.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1560-6) contains supplementary material, which is available to authorized users.

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“…In addition to cholesterol-lowering properties, statins are increasingly being recognized as a useful anti-inflammatory adjunct for cardiac surgery patients [38–40]. Current guidelines recommend the early initiation and continuation of high-intensity statin therapy after NSTE-ACS and continuation in the perioperative setting with a goal of an LDL-C less than 100 mg/dl with further titration to 70 mg/dl if possible [4,9,10,23].…”

Section: Utilization Of Cabg For Nste-acsmentioning

confidence: 99%

Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes

Yerokun

Williams

Gaca

et al. 2016

Coronary Artery Disease

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For patients with a non-ST-segment elevation acute coronary syndrome (NSTE-ACS), guideline recommendations and treatment pathways focus on revascularization for definitive treatment if the patient is an appropriate candidate. Despite the widespread use of revascularization for NSTE-ACS, most patients undergo a percutaneous coronary intervention, whereas a minority of patients undergo coronary artery bypass grafting. Focusing specifically on the USA, the contemporary utilization, preoperative and perioperative considerations, and outcomes of NSTE-ACS patients undergoing coronary artery bypass grafting have not been comprehensively reviewed.

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The effect of statins on perioperative inflammation in cardiac and thoracic surgery

Cited by 12 publications

References 40 publications

Statins for the prevention and treatment of acute lung injury and acute respiratory distress syndrome: A systematic review and meta‐analysis

Statins for the prevention and treatment of acute lung injury and acute respiratory distress syndrome: A systematic review and meta‐analysis

Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials

Indications, algorithms, and outcomes for coronary artery bypass surgery in patients with acute coronary syndromes

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