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Eur J Cardiothorac Surg 2006;29:861-862
© 2006 Elsevier Science NL

Letter to the Editor

Stress on pleiotropic effects of statins

Department of Cardiothoracic Surgery, 16 Alexandra Parade, Glasgow Royal Infirmary, Glasgow G31 2ER, UK

Received 22 December 2005; accepted 24 January 2006.

^_* Tel.: +44 141 5645206/2114731; fax: +44 141 2114845. (Email: mishrapk_25{at}yahoo.com).

Key Words: Statins • Pleiotropic effects • Radial artery

I read with interest recent article by Chello et al. [1] where they have discussed the effect of atorvastatin on arterial endothelial function following cardiopulmonary bypass. This is an excellent article well conceived and well written. I would like to add a few comments.

This article is another in a series of recent articles on pleiotropic effects of statins. Statins seem to be capable of modulating a number of abnormalities of inflammation, endothelial function and coagulation [2]. In recent times, it has become increasingly clear that the beneficial effects of statins extend well beyond their lipid lowering actions.

The clinical details of the patients (such as average age 54 ± 4.4 years, average number of grafts 2.3 ± 0.4) clearly indicate that that the patient population selected was relatively low risk to start with. The exclusion criteria (which included diabetes mellitus as well) ensured that these patients were in any case less liable to suffer from postoperative morbidity and mortality. Add to this the small sample size of the study and it is obvious that the results cannot be generalised to the average CABG patients in Europe. It is to be noted that the average age of CABG patient in Europe is approaching 70 years where the incidence of atherosclerosis of the vascular system and calcification of brachial and radial artery is much higher [3].

Brachial artery was used for assessment of endothelial function. The authors have not clarified whether radial artery was used as a conduit in any of these patients. Considering the younger age of the population they selected was it an institutional policy to avoid using radial artery or was radial artery conduit avoided for the academic exercise? In some patients diltiazem infusion was continued until 12 h before the first postoperative analysis. Can we have some more insight as to what was the indication of diltiazem infusion? I feel that the study could have excluded these patients.

Nine patients in the atorvastatin group were on calcium channel blockers preoperatively. Ultrasonic study of the brachial artery was carried till 5 days postoperatively. Did calcium channel blockers and statin continue in the postoperative period? The study did not measure (or mention) the effect of postoperative statin administration.

References

1. Chello M, Goffredo C, Patti G, Candura D, Melfi R, Mastrobuoni S, Di Sciascio G, Covino E. Effects of atorvastatin on arterial endothelial function in coronary bypass surgery. Eur J Cardiothorac Surg 2005;28(6):805-810.[Abstract/Free Full Text]
2. Ray KK, Cannon CP. Early time to benefit with intensive statin treatment: could it be the pleiotropic effects?. Am J Cardiol 2005;96(5A):54F-60F.[CrossRef][Medline]
3. Vaage J. Old skills in a new context. But do we want to use it?. Eur J Cardiothorac Surg 2005;28(6):831-832.[Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Pankaj Kumar Mishra Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Mishra, P. K. Search for Related Content PubMed PubMed Citation Articles by Mishra, P. K. Related Collections Cardiac - pharmacology Cardiac - other