Study Suggests That AAA Patients Should Be Considered for Statin Therapy
August 7, 2018—The Society for Vascular Surgery (SVS) announced that new evidence has been published suggesting that statin therapy is associated with a significant survival benefit in patients undergoing abdominal aortic aneurysm (AAA) repair. The findings were published by Thomas F.X. O'Donnell, MD, et al in Journal of Vascular Surgery (2018;68:392–399). Marc Schermerhorn, MD, led the investigators, who are from the Beth Israel Deaconess Medical Center in Boston, Massachusetts.
As background, although it is recommended that patients with carotid and peripheral vascular disease be considered for statin therapy because of atherosclerotic burden, this recommendation has not been made for those with AAA, despite the well-established association with this disease and coronary atherosclerosis.
According to SVS, both perioperative and long-term survival of patients undergoing AAA repair in relation to stain therapy were evaluated using data from the Vascular Quality Initiative. Outcomes were analyzed in 37,950 patients after either endovascular (29,257) or open (8,693) repair who were treated with statin therapy 69% (endovascular) and 66% (open).
As reported by SVS, the study found that statin therapy had no association with 30-day death or in-hospital stroke or myocardial infarction. Additionally, statin therapy resulted in improved survival at 1 year (94% vs 90%) and 5 years (85% vs 81%). Of those not taking statins, therapy was initiated before discharge 24% of the time. Statin therapy in this cohort of patients again realized a survival benefit at both one (94% vs 91%) and five (89% vs 81%) years.
The investigators stated, “Our results suggest that [the 2013 American College of Cardiology/American Heart Association lipid management guidelines] need to be reexamined. The association we found with long-term but not short-term outcomes implies that statins are not modifying the perioperative milieu; rather, the need for AAA repair is a marker of elevated risk. Consequently, we hypothesize that statin therapy in those patients does not affect their immediate postoperative course but provides secondary risk reduction similar to that seen in other atherosclerotic populations, such as patients with stroke, myocardial infarction, and peripheral artery disease.”
The investigators concluded in Journal of Vascular Surgery, "Preoperative statin therapy is associated with higher long-term survival but not perioperative mortality and morbidity in patients undergoing AAA repair, and initiating statin therapy in previously statin-naive patients is associated with markedly higher survival." They added, "All patients with AAAs without contraindications should receive statin therapy. In patients not taking a statin at the time of AAA repair, clinicians should consider initiating one before discharge."