Statins, Valve repair

[Marty]

Interesting item in my office E-mail today

Statins may be associated with poor survival outcomes following valve repair, research suggests.
MedPage Today (1/28, Peck) reported, "Patients who took statins before valve repair had a worse five-year survival than those not using the agents before surgery," German researchers found. In fact, "at five years, patients who used statins had a 69.7 percent survival rate versus 72.4 percent survival for patients who didn't use statins." For the study, researchers analyzed "outcomes in 15,096 patients who had valve repair surgery" in one hospital between May 1996 and May 2008. Of those patients, 4,225 "were taking statins" before surgery. The researchers found that "statin use was associated with a higher rate of low cardiac output and a higher 30-day mortality." Lead author Michael A. Borger, M.D., Ph.D., "said the results raise questions about the benefits of statin therapy that have been reported for coronary artery bypass graft patients."

 

[skeptic49]

Interesting...thanks for posting this, Marty.

Jim (not a fan of statins)

 

[Adrienne]

Are we sure that the reason for the difference in survival rates is not because the people who took statins had problems which led to their taking the statins that the people who did not take statins did not have? Sometimes you have to be careful of statistics.

 

[JeffM]

Are we sure that the reason for the difference in survival rates is not because the people who took statins had problems which led to their taking the statins that the people who did not take statins did not have? Sometimes you have to be careful of statistics.

Took the words right out of my mouth.

 

[hensylee]

that's very interesting. I took Lipitor for years but finally discarded it on my own (and my cardio agreed that some can't take it). I had quad bypass. Cardio rxed Zetia and now Humana (my drug plan) refuses to keep it in their medicine list unless my cardio sends them a letter saying I can't take statins. Wonder if this will make a difference!!! probly not.

I do think statins are bad for many and now your post confirms it.

 

[ponytaila1a]

I just began taking a statin last week. I am slated for valve repair in the spring.
I called the cardiologist (not the surgeon) at the CC and he ok'd it. I think I will call the surgeon's office. Thanks for the post.

 

[tobagotwo]

I'm no fan of statins (no kidding!), but wouldn't taking them mean that the patient was more likely to have been diagnosed with high cholesterol, and thus be more likely to have arterial plaque issues, and thus be more vulnerable to strokes after the use of catheterization and the trauma of open heart surgery? Might it not also indicate a likelihood of having had a longer interaction with a cardiologist, which might tend to be due to other, concurrent problems with the heart?

The issues were mostly within the first 30 days, when plaques that may have been loosened might let go, when endothelium is still not healed (peak stroke risk time) and when INR is less likely to have been fully stabilized.

I also note the unusually lousy survival length rates, which I interpret as possibly indicating a decidedly older-than-usual general patient population, another indicator for higher-than-normal stroke and death rates within five years. Generally, post-surgical survival is similar to normal life expectancies, which means most of these folks were likely to be 70 or over, to put them into the normal lifespan range. Since I doubt the Germans are terrible surgeons and caretakers, I'm betting on an age bias.

Sorry if this repeats some things others may have said, but it was written yesterday, and I just never got around to hitting enter...

Best wishes,

 

[Marty]

Bob, You are very likely right. Almost all the evidence states that statins are a life saver for many. I only personally know one person who they almost killed. Bad muscle reaction and then pancreatitis. I was at a dinner meeting not long ago. All the other doctors sitting at my table ,six or eight, were 35 40 years old. All were taking statins whether they had a cholesterol problem or not. I was the only one not taking them! I just don't like taking a lot of medicines. My only drug is warfarin.

 

[vprnet]

Seems to counter a recent study that said Lipitor was beneficial for heart surgery patients.

http://www.redorbit.com/news/health...r_risks_in_bypass_surgery_patients/index.html

Vincent
BAVR with 27mm ON-X with aortic conduit NYP Weill Cornell Dec 19, 2008.

PS. I am not a medical professional or a doctor. My comments in this forum are my own opinion and are not intended to be given as medical or professional advise or a recommendation of any valve choice. Decisions that affect your health and wellbeing are ultimately yours and your doctors. vprnet

 

[tobagotwo]

I don't really feel that what's provided adequately villifies statins for this particular indication. Too many unknowns, as well. Such as, were they all really repairs, or were some replacements? Did some of them also go through a CABG procedure along with the valve work, and if so, what was the mix, vis-a-vis statin usage?

Of course, the Mr. Hyde part of me comes out with sheer astonishment that these doctors are taking statins with no requirement for it. There are strong indications that statins can interfere with memory and decision-making processes in people whose normal-range cholesterol dips too low from taking them. Cholesterols are involved with the creation of memories in the brain, and in many other neural and life functions. You need a certain level of them available.

Nor do I personally think that statins are the right answer to the arteriosclerosis problem. They are only partially successful in what they do. Of course, there's really nothing else right now, so it's better than just letting nature take its course for those in severe trouble with lipids. The Jim Fixx's of the world will have to do with them for now. However, in many ways, it seems like treating a symptom to get at a disease. Even as indicators, cholesterol and even CRP are not all that reliable. We're missing something.

I'm looking for the next generation of anti-atheroma medications.


Best wishes,

 

[ChouDoufu]

"may be associated with ...........................research suggests."

this is about useless. too many variables. no definition on terms.....valve repair
surgery? is replacement considered a repair? x number taking 'statins.' well,
what kind of statins, what strength, what is the reason for taking them? more
likely that the problem for which statins are prescribed is what is affecting morbidity.

anyway, this 'study' seems awfully poorly done. and if i remember anything from
college stats, i'm pretty sure that with a population of 15k (no breakdown!!!),
69.7 percent versus 72.4 percent is statistically insignificant.