Harvard Heart Letter

Heart Beat: Statins before vascular surgery

Heart Beat

Statins before vascular surgery

If you need vascular surgery to fix a narrowed, ruptured, or otherwise damaged blood vessel, don't be surprised if your doctor asks you to start taking a statin (if you don't already) before the operation. Doing so can help avoid postoperative myocardial ischemia — a shortage of blood flow to the heart muscle. In a large Dutch trial called DECREASE III, taking fluvastatin (Lescol) for a month before and after surgery also halved the number of postoperative deaths and heart attacks from 10% among those who didn't take fluvastatin to 5% among those who did (New England Journal of Medicine, Sept. 3, 2009).

Heart attack, stroke, and other cardiovascular events happen fairly often after vascular procedures such as removing fat deposits from a carotid artery (carotid endarterectomy), repairing an abdominal aortic aneurysm or aortic dissection, stripping varicose veins, or opening a clogged leg artery. Sometimes they happen because of a supply-demand mismatch for oxygenated blood in the heart muscle. Other times the surgery causes a cholesterol-filled plaque inside a coronary artery to burst. This creates a clot that can block blood flow to part of the heart, causing a heart attack, or to part of the brain, causing a stroke. Statins may stabilize plaques. They may also calm the inflammation that is part of the mechanics of plaque rupture.

The findings support recommendations from the American Heart Association and others that statin therapy be started before vascular surgery regardless of an individual's heart attack risk factors.

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