A new study presented at the 95th annual Clinical Congress of the American College of Surgeons says that patients taking cholesterol-lowering statin drugs may have better results and lower procedure costs when having a common operation for repairing a bulging aorta.
"We think that anyone with a diagnosis of abdominal aortic aneurysm would signifi-cantly benefit from being on a statin before the operation," reported Michael Morgan McNally, MD, study coauthor from the East Carolina Heart Insitute of the Brody School of Medicine, East Carolina University in Greenville, NC.
Abdominal aortic aneurysm (AAA) is the medical term for an aorta that widens to three inches or more in diameter and three to four times its normal diameter, causing risk of rupture. The largest blood vessel in the body, the aorta connects the heart to branch arteries throughout the body.
Approximately five percent of men over age 60 will develop AAA, according to the American Heart Association.
Dr. McNally and his colleagues investigated 401 cases of AAA repair surgery at their institution. Regardless of what type of procedure patients had--whether the traditional open repair or the endovascular approach, in which the repair is done from inside the aorta--statin users typically had fewer complications and a lower chance of postoperative death. This result held true even though the statin users had more concurrent health problems than the control subjects did.
None of the statin patients in the study died after the AAA repair procedure, whereas five percent of those not taking statins died after the operation. "The study findings point to the powerful risk reduction ascribed to statins and highlights the importance of giving these drugs to patients undergoing cardiovascular procedures," Dr. McNally said. "These patients should get on statin therapy as early as possible, but our study saw a significant benefit even after only 30 days on a statin," he said.
The investigators also determined that the total costs for AAA repair was lower for statin patients, again regardless of what procedure they underwent. The endovascular approach cost on average $33,237 per patient on statin drugs versus $36,442 in control patients; the open approach cost $18,647 per statin patient compared with $22,440 in the control group. "The study focuses on the financial impact of this approach and the importance of this for the health care system," Dr. McNally said.
"The bottom line is that risk optimization in the workup of any patient having AAA repair is imperative," Dr. McNally added. "The workup would include looking at their medications and what they''ve been on preoperatively."
The next step is for the researchers to examine the individual clinical outcomes behind the cost savings, and to investigate the potentially protective properties of other commonly prescribed cardiovascular medications, including beta blockers and angiotensin-converting enzyme inhibitors. Furthermore, these data demonstrate the importance of examining the role of preoperative risk optimization in registries, databases, and future prospective studies, said Dr. McNally.
In addition to Dr. McNally, Steven C. Agle, MD, MPH; Samuel A. Hayes, BS; Frank M. Parker, DO, FACS; William M. Bogey, MD, FACS; Charles S. Powell, MD, FACS; and Michael C. Stoner, MD, FACS, participated in the study.