What Surgical Patients Need to Know About Statins

Cholesterol medication withholding prior to surgery may increase mortality risk

(RxWiki News) Despite recent recommendations from heart health experts, many patients may still be discontinuing their cholesterol medications before non-cardiac surgery.

A new study from the University of California at San Francisco (UCSF) found that patients who discontinue statin use for surgery may significantly increase their risk of death. According to the authors of this study, statins often come with a package insert that warns patients to temporarily discontinue use when undergoing surgery.

Statins are a class of drugs used to lower cholesterol and prevent heart disease. Drugs that fall within this class include atorvastatin (brand name Lipitor), simvastatin (Zocor) and pravastatin (Pravachol), among others.

"Unfortunately, the drug information for statins still comes with a warning to temporarily discontinue them during surgery," said lead study author Susan M. Lee, MD, a clinical instructor in the Department of Anesthesia and Perioperative Care at UCSF, in a press release. "Patients and their doctors need to understand the importance of continuing statins throughout surgery, a simple act that may reduce the risk of complications and death after the procedure."

In 2002, the American College of Cardiology, the American Heart Association and the National Heart, Lung, and Blood Institute issued a clinical advisory that surgical patients should temporarily discontinue statin treatment to reduce the risk of myopathy (a disorder that results in muscle weakness).

In 2007, however, these organizations began calling for the uninterrupted use of statins before and after surgery, noting that the drugs reduce inflammation and promote blood flow.

The findings of this study suggest that many patients are still following outdated recommendations.

For this study, Dr. Lee and team looked at the records of 258,812 patients who were were admitted to the Veterans Affairs Healthcare system for non-cardiac surgery between 1999 and 2011. All of these patients were prescribed statins.

Dr. Lee and team found that about 32 percent had not resumed statin use within two days after surgery.

In the 30 days after surgery, those who resumed statins within two days had a mortality rate of 1.4 percent, while those who abstained from statins for more than two days had a mortality rate of 2.3 percent.

These rates were found even after accounting for illness and surgical risk factors.

This study was presented Oct. 27 at the 2015 American Society of Anesthesiologists annual conference. Research presented at conferences may not have been peer-reviewed.

Information on funding sources and conflicts of interest was not available at the time of publication.

Review Date: 
October 27, 2015