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Applications of statins in cardiothoracic surgery: more than just lipid-lowering

Department of Clinical Biochemistry (Vascular Disease Prevention Clinics) and Academic Department of Surgery, Royal Free Hospital, Pond Street, London NW3 2QG, UK

Received 10 October 2007; received in revised form 12 December 2007; accepted 12 December 2007.

^_* Corresponding author. Tel.: +44 20 7830 2258; fax: +44 20 7830 2235. (Email: paraskevask{at}hotmail.com).

Statins exert several actions in cardiothoracic surgical procedures besides lipid-lowering. In patients undergoing coronary artery bypass grafting (CABG), statins improve bypass graft patency, perioperative as well as long-term mortality rates. In addition, statins reduce the number of postoperative complications and clinical events, revascularization rates and postoperative hospital stay (as well as associated costs). Furthermore, they are protective against de novo atrial fibrillation and renal dysfunction following CABG. In cardiac transplantation, statins decrease cardiac allograft vasculopathy and cardiac rejection rates. They are also associated with a significant reduction in mortality rates in cardiac transplant patients. According to the results of a meta-analysis, statins are associated with one life saved for every 8.5 heart transplant recipients treated for 1 year. Alternatively, routine statin treatment in cardiac transplant patients might have the potential to save 471 lives each year among the 4000 heart transplantation operations performed worldwide. The results from several studies suggest that statins may also play a role in heart valve surgery, lung transplantation, pulmonary resection and thoracic aortic aneurysm repair. Statin use is safe and cost-effective. Despite the multiple beneficial effects of statin therapy, there is evidence suggesting that a large percentage of cardiothoracic surgical patients are suboptimally treated with respect to statins. Risk management in these patients should be improved to reduce cardiovascular morbidity and mortality rates.

Key Words: Statins • Coronary artery bypass grafting • Cardiac transplantation • Valve surgery • Cardiac surgery • Thoracic aortic aneurysm

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