Improved Postoperative Outcomes Associated with Preoperative Statin Therapy

2006 ◽  
Vol 105 (6) ◽  
pp. 1260-1272 ◽  
Author(s):  
Katja Hindler ◽  
Andrew D. Shaw ◽  
Joshua Samuels ◽  
Stephanie Fulton ◽  
Charles D. Collard ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Statin Treatment ◽  
Postoperative Outcomes ◽  
Lipid Lowering ◽  
Mortality And Morbidity ◽  
Risk Of Mortality ◽  
Prospective Trials ◽  
Lipid Lowering Effect

Statin therapy is well established for prevention of cardiovascular disease. Statins may also reduce postoperative mortality and morbidity via a pleiotropic (non-lipid-lowering) effect. The authors conducted a meta-analysis to determine the influence of statin treatment on adverse postoperative outcomes in patients undergoing cardiac, vascular, or noncardiovascular surgery. Two independent authors abstracted data from 12 retrospective and 3 prospective trials (n = 223,010 patients). A meta-analysis was performed to evaluate the overall effect of preoperative statin therapy on postoperative outcomes. Preoperative statin therapy was associated with 38% and 59% reduction in the risk of mortality after cardiac (1.9% vs. 3.1%; P = 0.0001) and vascular (1.7% vs. 6.1%; P = 0.0001) surgery, respectively. When including noncardiac surgery, a 44% reduction in mortality (2.2% vs. 3.2%; P = 0.0001) was observed. Preoperative statin therapy may reduce postoperative mortality in patients undergoing surgical procedures. However, the statin associated effects on postoperative cardiovascular morbidity are too variable to draw any conclusion.

scholarly journals Folate, neopterin and kynurenine pathway in patients with statin therapy

Pteridines ◽  
2016 ◽  
Vol 27 (1-2) ◽  
pp. 7-12
Author(s):  
Saziye Sezin Palabiyik ◽  
Gozde Girgin ◽  
Ali Asci ◽  
Selami Demirelli ◽  
Abdulkadir Uslu ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Statin Treatment ◽  
Kynurenine Pathway ◽  
Lipid Lowering ◽  
Folate Status ◽  
Tryptophan Degradation ◽  
Cardiology Clinic ◽  
Erythrocyte Folate ◽  
Urinary Neopterin ◽  
Lipid Lowering Effect

AbstractStatins, widely used antihyperlipidemic drugs, also have immunomodulatory properties independent from their lipid lowering effect. Even with slight modulations in the immune system, pteridine levels can display changes. The effect of statins on pteridines and related pathways has been demonstrated in a limited number of studies. The aim of the study was to evaluate the possible changes in neopterin and folate levels, and tryptophan (Trp) degradation in hyperlipidemic patients. Patients who were admitted to the cardiology clinic were randomly grouped if they were having statin treatment (n=69) or not (n=36). Serum Trp and kynurenine (Kyn), erythrocyte folate, and urinary neopterin levels were measured. It was found that urinary neopterin levels were significantly higher in patients on statin treatment (p<0.05) while levels of folate, Trp, Kyn, and Kyn-to-Trp ratios (Kyn/Trp) presented no significant changes (all, p>0.05). The correlation of the measured parameters was also evaluated and neopterin, folate and tryptophan degradation were found to be positively correlated. According to the results, neopterin levels, folate status and Trp degradation were altered in patients with statin treatment in comparison with the patients not receiving statin therapy. In order to point out the direct effect of statins on pteridines, further studies presenting both pre- and post-statin treatment of these parameters are needed.

scholarly journals KIF6 gene as a pharmacogenetic marker for lipid-lowering effect in statin treatment

PLoS ONE ◽  
2018 ◽  
Vol 13 (10) ◽  
pp. e0205430 ◽  
Author(s):  
Cristina Ruiz-Iruela ◽  
Ariadna Padró-Miquel ◽  
Xavier Pintó-Sala ◽  
Neus Baena-Díez ◽  
Assumpta Caixàs-Pedragós ◽  
...  
Keyword(s):  
Statin Treatment ◽  
Lipid Lowering ◽  
Lowering Effect ◽  
Lipid Lowering Effect

scholarly journals Modern statin therapy in clinical practice: The lower the better

2013 ◽  
Vol 141 (1-2) ◽  
pp. 104-106 ◽  
Author(s):  
Edita Stokic
Keyword(s):  
Heart Disease ◽  
Cardiovascular Risk ◽  
Ischemic Heart Disease ◽  
Statin Therapy ◽  
Meta Analysis ◽  
Ischemic Heart ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
Coronary Events ◽  
Risk Treatment

Lipid and lipoprotein disorders are well known risk factors for atherosclerosis and its complications. The level of atherogenic LDL-cholesterol (LDL-C) is directly related to an increased risk of occurrence and progression of ischemic heart disease. Epidemiological and clinical studies have shown that the use of statin therapy to decrease LDL-C can significantly reduce the incidence of mortality, major coronary events and the need for revascularization procedures in the different groups of patients. The findings of a large meta-analysis conducted by the Cholesterol Treatment Trialists? (CTT) collaborators showed that every 1.0 mmol/l reduction of atherogenic LDL-C is associated with a 22% reduction in cardiovascular diseases mortality and morbidity. However, despite the impressive results of the benefits of statin therapy, the EUROASPIRE study showed that about 50% of patients with ischemic heart disease did not achieve target LDL-C levels. According to the new ESC/EAS Guidelines for the Management of Dyslipidaemias in patients with a very high cardiovascular risk, treatment goal should be to decrease LDL-C below 1.8 mmol/l or ?50% of initial values. In the majority of patients that can be achieved by statin therapy. For this reason an adequate choice of statins is of crucial importance, whereby the needed reduction in atherogenic LDL-C, after the identification of its target level based on the assessment of total cardiovascular risk, can be achieved.

P5015Efficacy of lipid lowering therapy beyond statins to prevent cardiovascular events: A meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Dykun ◽  
R Mincu ◽  
M Totzeck ◽  
T Rassaf ◽  
A A Mahabadi
Keyword(s):  
Myocardial Infarction ◽  
Relative Risk ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

Abstract Background Lipid lowering therapy is a key cornerstone in secondary prevention of patients with coronary artery disease. However, only a minority of patients with statin therapy reach LDL thresholds as suggested by the ESC. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors allow for reduction in LDL-cholesterol in addition to statin therapy. Purpose To perform a meta-analysis of existing trials, evaluating how lipid lowering therapy beyond statins impacts cardiovascular outcome. Methods We performed a systematic search using the Pubmed, Cochrane, SCOPUS, and Web of Science databases for studies, evaluating the impact of an intensified lipid lowering therapy via ezetimibe or PCSK-9 inhibitor in addition to statin therapy compared to statin therapy alone. Manuscript and congress presentations, published until 1st of November 2018, were included. We made our search specific and sensitive using Medical Subject Headings terms and free text and considered studies published in English language. Search terms used were “ezetimibe”, “evolocumab”, “alirocumab”, or “bococizumab” and “cardiovascular events”. Results A total of 100,610 patients from 9 randomized controlled trials (IMPROVE-IT, FOURIER, ODYSSEY Outcomes, SIPRE I, SPIRE II, ODYSSEY LONG TERM, OSLER-1 and OSLER-2, HIJ-PROPER) were included. Treatment with ezetimibe or a PCSK-9 inhibitor was associated with a 18% risk reduction in cardiovascular events (OR [95% CI]: 0.82 [0.75–0.89]). Effect sizes were similar for myocardial infarction (0.84 [0.76–0.92]) and even more pronounced for ischemic stroke (0.77 [0.67–0.83]). In contrast, all-cause mortality was not improved by the intensified lipid lowering therapy (0.94 [0.85–1.05]). No relevant heterogeneity and inconsistency between groups was present in all analyses (detailed data not shown). Comparing efficacy of LDL-reduction and relative risk redaction of cardiovascular events, a linear relationship was observed (figure). Figure 1. Correlation of reduction of LDL-cholesterol at one year with relative risk reduction (95% confidence interval) of cardiovascular events in included trials. Conclusion Intensified LDL-lowering therapy with ezetimibe or PCSK-9 inhibitors, in addition to statins, reduces the risk of myocardial infarction and stroke, however, does not impact overall mortality. There is a linear relationship between LDL reduction and cardiovascular risk reduction, confirming the beneficial effects of LDL lowering therapy beyond statins in secondary prevention.

Effects of Perioperative Dexmedetomidine on Postoperative Mortality and Morbidity: A Systematic Review and Meta-analysis

2019 ◽  
Vol 41 (1) ◽  
pp. 138-154.e4 ◽  
Author(s):  
Ke Peng ◽  
Fu-hai Ji ◽  
Hua-yue Liu ◽  
Juan Zhang ◽  
Qing-cai Chen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Postoperative Mortality ◽  
Mortality And Morbidity

Impact of statin therapy on plasma levels of plasminogen activator inhibitor-1

2016 ◽  
Vol 116 (07) ◽  
pp. 162-171 ◽  
Author(s):  
Amirhossein Sahebkar ◽  
Cristiana Catena ◽  
Kausik Ray ◽  
Antonio Vallejo-Vaz ◽  
Željko Reiner ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Plasminogen Activator ◽  
Publication Bias ◽  
Plasma Levels ◽  
Meta Analysis ◽  
Plasminogen Activator Inhibitor ◽  
Lipid Lowering ◽  
Plasminogen Activator Inhibitor 1 ◽  
Activator Inhibitor ◽  
Pai 1

SummaryElevated plasma levels of the pro-thrombotic and pro-inflammatory factor plasminogen activator inhibitor-1 (PAI-1) may contribute to the pathogenesis of atherosclerotic cardiovascular disease. Beyond their lipid-lowering effect, statins have been shown to modulate plasma PAI-1 levels but evidence from individual randomised controlled trials (RCTs) is controversial. Therefore, we aimed to assess the potential effects of statin therapy on plasma PAI-1 concentration through a meta-analysis of RCTs. We searched Medline and SCOPUS databases (up to October 3, 2014) to identify RCTs investigating the effect of statin therapy on plasma PAI-1 concentrations. We performed random-effects meta-analysis and assessed heterogeneity (I2 test, subgroup and sensitivity analyses) and publication bias (funnel plot, Egger and “trim and fill” tests). Sixteen RCTs (comprising 19 treatment arms) were included and pooled analyses showed a significant effect of statins in reducing plasma PAI-1 concentrations (weighted mean difference WMD: –15.72 ng/ml, 95 % confidence interval [CI]: –25.01, –6.43,). In subgroup analysis, this effect remained significant in with lipophilic statins (atorvastatin and simvastatin) (WMD: –21.32 ng/ml, 95 % CI: –32.73, –9.91, I2=99 %) and particularly atorvastatin (WMD: –20.88 ng/mL, 95 % CI: –28.79, –12.97, I2=97 %). In the meta-regression analysis, the impact of statins on PAI-1 did not correlate with the administered dose, duration of treatment and changes in plasma LDL-cholesterol concentrations. Finally, evidence of publication bias was observed. In conclusion, taking into account the limit of heterogeneity between studies, the present meta-analysis suggests that statin therapy (mainly atorvastatin) significantly lowers plasma PAI-1 concentrations.

Impact of the Type of Anesthesia on Outcome after Elective Endovascular Aortic Aneurysm Repair: Literature Review

Vascular ◽  
2008 ◽  
Vol 16 (6) ◽  
pp. 340-345 ◽  
Author(s):  
Umar Sadat ◽  
David G. Cooper ◽  
Jonathan H. Gillard ◽  
Stewart R. Walsh ◽  
Paul D. Hayes
Keyword(s):  
Hospital Stay ◽  
General Anesthesia ◽  
Endovascular Aneurysm Repair ◽  
Postoperative Mortality ◽  
Postoperative Outcomes ◽  
Mortality And Morbidity ◽  
Icu Stay ◽  
Locoregional Anesthesia ◽  
Aneurysm Repair ◽  
The Impact

The type of anesthesia used during aneurysm repair affects postoperative outcomes for the patient. Although endovascular aneurysm repair (EVAR) appears to improve surgical outcomes, by convention, general anesthesia remains predominantly used. The aim of this study was to compare the impact of the type of anesthesia (ie, locoregional versus general anesthesia) on the outcomes following EVAR. A literature search was carried out using the PubMed search engine to find relevant published articles that compared locoregional and general anesthesia in patients undergoing EVAR. The review of the selected studies showed that although patients in the locoregional group were less medically fit compared with those in the general anesthesia group, there was a reduction in the cardiovascular support required during and after the surgery, postoperative hospital stay, intensive care unit (ICU) stay, and postoperative mortality and morbidity. Although there is no level 1 evidence for or against locoregional anesthesia in EVAR, conventionally, EVAR has been performed under general anesthesia. But this is rooted in tradition rather than evidence. This review suggests that locoregional anesthesia can improve postoperative outcomes following EVAR by reducing hospital stay, ICU stay, mortality, and morbidity, although other factors may also have some influence.

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