CHICAGO, Illinois, March 31, 2016 - For some vascular surgery patients, starting an antiplatelet and a cholesterol medication after surgery can significantly extend their lives, even if they don’t have high cholesterol.
A recent review of patients who had undergone carotid, lower extremity bypass, or abdominal aortic aneurysm surgeries found that those who received those medications were far more likely to be alive five years later, even though they were at high risk for stroke or cardiac death.
Of those prescribed both medications, 82 percent were alive five years later; of those who received neither drug, 67 percent were still alive. Looking at those who received only one of the medications, the rate was 77 percent for anti-platelets and 73 percent for statins. The review used national data collected by the Vascular Quality Initiative, a division of the Society for Vascular Surgery, and was published in the Journal of Vascular Surgery (PubMed).
Patients who have had one of these surgeries tend to be an older, high-risk population and are prone to complications after surgery.
All the evidence suggests they should be medicated, said study lead Dr. Randall DeMartino, vascular surgeon at Mayo Clinic, but only about two-thirds of the patients in the review actually received a statin and/or anti-platelet prescription after surgery. That left more than 30 percent at higher risk of a fatal vascular event.
Some patients won’t take a statin because they fear side effects or cannot afford it. Others may fall through the cracks between getting surgical discharge instructions and any follow up with their primary care physician, who would normally manage their medications.
“I wanted to see how good we were at maximizing the benefits of statins and anti-platelets,” DeMartino said. “Surprisingly, we are not as good as we might like to be. We should be able to identify someone who is not being adequately treated and educate providers who are not as attentive at ensuring this. Not taking medications is associated with a much worse outcome.”
Compared to the whole population, Latinos and African Americans were somewhat less likely to receive medications post-surgery. Others who tended not to receive meds were amputees, nursing home residents, dialysis patients and those with congestive heart failure or chronic obstructive pulmonary disease.
The review looked at patients who had one of the specified procedures, as long as it was their first one. These patients were likely to have had coronary disease, diabetes and/or high blood pressure. But even with those complications they still did better than patients who did not take statins.
Statins lower low density lipoprotein (LDL) cholesterol and make atherosclerotic plaques (cholesterol build-up in blood vessels) more stable, so they are less likely to break apart and cause heart attack or stroke. This occurs even in people with normal cholesterol levels.
Surgery patients who don’t have high cholesterol might think they could skip this medication, but that’s not a good strategy. Statins, DeMartino noted, have other effects on the vascular system besides just lowering LDL. They have a positive effect on vessel inflammation and have been shown to stabilize plaques.
“High cholesterol is just one marker for taking a statin,” he said, “but not the only one. Statins have other effects on the vascular system, particularly in regards to vessel inflammation and plaque stabilization. People shouldn’t get too fixated on cholesterol numbers.
“But patients who have just had vascular surgery and are not on these medications should ask their primary care doctor if that would be the right treatment for them.”
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For an accompanying infographic (.eps, .jpg, .pdf) visit https://www.dropbox.com/sh/tuia3e9oddz7wj3/AAB4eG6VG8SZMMHnky2e0NkCa?dl=0
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The Society for Vascular Surgery® (SVS) is a 5,300-member not-for-profit professional medical society, composed primarily of specialty-trained vascular surgeons, that seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness. The society is based in Chicago, Illinois.