Statins before carotid surgery may be beneficial
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Patients with symptoms of low blood flow to the brain who take statins before undergoing carotid endarterectomy, a type of surgery that may help prevent strokes, may fare better early after the surgery than those who do not, Canadian researchers have found.
The carotid arteries, which lie on each side of the neck, are the major vessels that supply blood to the brain. Strokes can occur when plaques that have formed in the carotids break off or otherwise obstruct blood flow to the brain. Carotid endarterectomy involves making a small incision in the affected artery and inserting an instrument to remove the plaque.
The current study shows that those taking statins are “less likely to die or have a stroke due to the operation,” said study chief Dr. James Kennedy. Why this is so is not exactly clear and requires further study. Nonetheless, the current study suggests that individuals having vascular surgery “may benefit from being on a statin prior to surgery,” he said.
Kennedy of the University of Alberta, Edmonton, and colleagues note that statin use has been associated with a reduction in mortality in non-cardiac surgery and they sought to determine whether this might also be true in patients admitted for carotid endarterectomy.
The researchers reviewed the records of more than 3000 patients who underwent the procedure during a 2-year period. Overall, 815 of 2031 patients with symptoms of low blood flow to the brain (i.e., the symptomatic patients) and 665 of 1252 symptom-free patients were taking a statin at the time of hospital admission.
Neither group showed an improvement in in-hospital cardiac outcomes, but statin use by symptomatic patients was associated with a reduced risk of experiencing a stroke while still in the hospital or of dying in the hospital. No benefit was seen in the patients who did not have symptoms prior to the surgery.
Despite the apparent beneficial effects of statins in symptomatic patients, the researchers note the study was observational and the ostensible advantage “now needs to be explored in rigorously performed randomized controlled trials.”
In an accompanying editorial, Dr. David M. Kent of Tufts-New England Medical Center, Boston, notes that given the size of the study “the results cannot be dismissed lightly,” but agrees with the need for rigorous testing.
SOURCE: Stroke, October 2005.
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