Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial
Open accessAbstract
Objectives This prospective, randomized, placebo-controlled, double-blind clinical trial was performed to analyze the effect of atorvastatin compared with placebo on the occurrence of a 6-month composite of cardiovascular events after vascular surgery. Cardiovascular complications are the most important cause of perioperative morbidity and mortality among patients undergoing vascular surgery. Statin therapy may reduce perioperative cardiac events through stabilization of coronary plaques.Methods One hundred patients were randomly assigned to receive 20 mg atorvastatin or placebo once a day for 45 days, irrespective of their serum cholesterol concentration. Vascular surgery was performed on average 30 days after randomization, and patients were prospectively followed up over 6 months. The cardiovascular events studied were death from cardiac cause, nonfatal myocardial infarction, unstable angina, and stroke.Results Fifty patients received atorvastatin, and 50 received placebo. During the 6-month follow-up primary end points occurred in 17 patients, 4 in the atorvastatin group and 13 in the placebo group. The incidence of cardiac events was more than three times higher with placebo (26.0%) compared with atorvastatin (8.0%; P =.031). The risk for an event was compared between the groups with the Kaplan-Meier method, as event-free survival after vascular surgery. Patients given atorvastatin exhibited a significant decrease in the rate of cardiac events, compared with the placebo group, within 6 months after vascular surgery (P =.018).Conclusion Short-term treatment with atorvastatin significantly reduces the incidence of major adverse cardiovascular events after vascular surgery.
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The adverse lipid effects of immunosuppressive drugs differ between drugs.
“These effects vary with different immunosuppressive drugs [497,498,502-506].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [498]
Immunosuppressive drug regimens can adversely affect lipid metabolism, raising total cholesterol, VLDL, triglycerides, and LDL particle size and density.
“Immunosuppressive drug regimens may have adverse effects on lipid metabolism leading to increases in TC, VLDL, and TGs, and in the size and density of LDL particles.”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [498]
These dyslipidaemias increase the risk of atherosclerotic cardiovascular disease and transplant arterial vasculopathy in transplant recipients.
“Dyslipidaemias are very common in patients who have undergone heart, lung, liver, kidney, or allogenic haematopoietic stem cell transplantation, and predispose such patients to an increased risk of developing ASCVD and transplant arterial vasculopathy [497-501].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [498]
Dyslipidaemias are very common in recipients of heart, lung, liver, kidney, or blood-forming stem cell transplants.
“Dyslipidaemias are very common in patients who have undergone heart, lung, liver, kidney, or allogenic haematopoietic stem cell transplantation, and predispose such patients to an increased risk of developing ASCVD and transplant arterial vasculopathy [497-501].”
From 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk (2019) · cites this paper as [498]
In an RCT, atorvastatin 20 mg versus placebo significantly reduced the composite endpoint of cardiac death, MI, stroke, and unstable angina in 100 patients undergoing vascular non-cardiac surgery including abdominal aortic aneurysm repair.
“In an RCT comparing atorvastatin 20 mg with placebo, the composite endpoint of cardiac death, MI, stroke, and unstable angina was significantly reduced in 100 patients undergoing vascular non-cardiac surgery, including abdominal aortic aneurysm repair.208”
From ESC/EAS Guidelines for the management of dyslipidaemias (2011) · cites this paper as [208]
In a randomized trial comparing atorvastatin 20 mg with placebo in 100 patients undergoing vascular non-cardiac surgery including abdominal aortic aneurysm repair, the composite endpoint of cardiac death, myocardial infarction, stroke and unstable angina was significantly reduced.
“In an RCT comparing atorvastatin 20 mg with placebo, the composite endpoint of cardiac death, MI, stroke and unstable angina was significantly reduced in 100 patients undergoing vascular non-cardiac surgery, including abdominal aortic aneurysm repair. 417”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [417]
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- Authors
- Durazzo, A. E. S., Machado, F. S., Ikeoka, D. T., De Bernoche, C., Monachini, M. C., Puech-Leão, P., & Caramelli, B.
- Affiliations
- Universidade de São Paulo (BR)
- Corresponding author
- Durazzo, Anai E.S
- Venue
- Journal of Vascular Surgery
- Publisher
- Elsevier BV
- Published
- 2004-05
- Volume
- 39
- Issue
- 5
- Pages
- 967-975
- ISSN
- 0741-5214 (ISSN-L)
- OpenAlex
- W2030475349
- Cited by
- 595
- References
- 34
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 12 · 2023: 11 · 2022: 6 · 2021: 15 · 2020: 19 · 2019: 11 · 2018: 17 · 2017: 18 · 2016: 27 · 2015: 23 · 2014: 36 · 2013: 27 · 2012: 33
- FWCI
- 33.54
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Vascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Fundação de Amparo à Pesquisa do Estado de São Paulo
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac, Anesthesia and Surgical Outcomes
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- atorvastatin, vascular surgery, perioperative cardiovascular events, statin therapy, myocardial infarction, unstable angina, stroke, cardiac mortality, event-free survival
- MeSH terms
- Atorvastatin, Aged, Cardiovascular Diseases, Double-Blind Method, Female, Follow-Up Studies, Heptanoic Acids, Humans, Cholesterol, LDL, Male, Patient Compliance, Postoperative Complications, Prospective Studies, Pyrroles, Risk Factors, Time Factors, Vascular Surgical Procedures, Incidence, Hydroxymethylglutaryl-CoA Reductase Inhibitors
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