NEW YORK (Reuters Health) - Treatment with lipid-lowering agents, particularly statins, may reduce the risk of death after major noncardiac surgery, according to a report published in the Journal of the American Medical Association for May 5.

In the new study, patients who used such agents on at least the first or second hospital day were 38% less likely to die while hospitalized than nonusers.

"Beta-blockers have been shown to benefit patients when given around the time of surgery," lead author Dr. Peter K. Lindenauer, from Baystate Medical Center in Springfield, Massachusetts, told Reuters Health. "But such therapy doesn't completely eliminate the risk of postoperative complications, so there's still a need for other therapies that can improve patient safety."

"Statins have been shown to have a number of effects that may help stabilize atherosclerotic plaques," Dr. Lindenauer noted. "Since rupture of such plaques is thought to be responsible for most postoperative myocardial infarctions and other adverse events," it seemed logical to look at the effect of lipid-lowering therapy on mortality after surgery, he added.

The results are based on a study of more than 780,000 patients who underwent major noncardiac surgery in the US during 2000 and 2001. The operations included a variety of general, gynecologic, and specialist procedures. Patients who used lipid-lowering agents on the first or second hospital day were classified as users.

Overall, 2.96% of patients died during hospitalization, the authors report. The mortality rate for patients treated with lipid-lowering agents was 2.18%, significantly lower than the 3.15% rate seen for nonusers (p < 0.001). The reduction in mortality was more pronounced with statins than with other lipid-lowering agents.

Based on the risk reduction seen with lipid-lowering therapy, 85 patients would need to be treated with such drugs to prevent one postoperative death. For lower risk patients, the number needed to treat increased to 186, whereas for higher risk patients only 30 were needed to prevent one death.

So, should every patient undergoing major surgery now receive lipid-lowering therapy? Dr. Lindenauer believes that it is too early to make this conclusion. "Our study was observational and I think the findings really need to be confirmed in a randomized clinical trial."

One of the key issues that needs to be addressed, according to Dr. Lindenauer, is the timing and duration of therapy needed to produce a benefit. In the present study, these parameters could not be evaluated since patients were lumped together in one "user group" if use on hospital day 1 or 2 was recorded.

JAMA 2004;291:2092-2099.

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