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World Journal of Surgery

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01-10-2018 | Scientific Review

Effect of Statin Therapy on Survival After Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis

Authors: Qun Huang, Han Yang, Qiuning Lin, Ming Hu, Yuanbiao Meng, Xiao Qin

Published in: World Journal of Surgery | Issue 10/2018

Abstract

Background

No consensus exists on the effect of statin therapy on survival after abdominal aortic aneurysm (AAA) repair. The objective of this review was to systematically review the literature to investigate whether statin therapy is associated with improved outcomes after AAA repair.

Methods

We searched PubMed, Embase, and Cochrane Library to find relevant randomized controlled trials and cohort studies. Outcomes of interest included long-term mortality and short-term mortality and perioperative cardiac complications.

Results

Nine cohort studies and one post hoc study of a randomized controlled trial were included, giving a total of 28,496 enrolled patients. Compared with nonusers of statins, statin use was associated with significantly lower long-term mortality (HR 0.57, 95% CI 0.47–0.69, I² = 70.1%), short-term mortality (RR 0.60, 95% CI 0.38–0.98, I² = 51.7%), and fewer perioperative cardiac complications (RR 0.46, 95% CI 0.26–0.80, I² = 0%).

Conclusions

The results suggest that statin therapy has beneficial effects on survival after AAA repair and statins should be recommended to patients who will receive open or endovascular AAA repair. However, these findings mainly relied on data from cohort studies, and the high-quality studies are still needed to further validate our conclusions.

Margaritis M, Channon K, Antoniades C (2013) Statins as regulators of redox state in the vascular endothelium: beyond lipid lowering. Antioxid Redox Signal 20:1198–1215CrossRef

Durazzo AE, Machado FS, Ikeoka DT et al (2004) Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 39:967–975 (discussion 975–966) CrossRefPubMed

O’Neil-Callahan K, Katsimaglis G, Tepper MR et al (2005) Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol 45:336–342CrossRefPubMed

Hirsch AT, Haskal ZJ, Hertzer NR et al (2012) ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): a Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery. J Vasc Interv Radiol (JVIR) 17:1383CrossRef

Raux M, Cochennec F, Becquemin JP (2012) Statin therapy is associated with aneurysm sac regression after endovascular aortic repair. J Vasc Surg 55:1587–1592CrossRefPubMed

Zhang W, Liu Z, Liu C (2015) Effect of lipid-modifying therapy on long-term mortality after abdominal aortic aneurysm repair: a systemic review and meta-analysis. World J Surg 39:794–801. https://doi.org/10.1007/s00268-014-2858-7 CrossRefPubMed

Galinanes EL, Reynolds S, Dombrovskiy VY et al (2015) The impact of preoperative statin therapy on open and endovascular abdominal aortic aneurysm repair outcomes. Vascular 23:344–349CrossRefPubMed

Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ (Clinical research ed) 339:b2700CrossRef

Higgins JP, Altman DG, Gotzsche PC et al (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed) 343:d5928CrossRef

10.

The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

11.

Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 327:557–560CrossRef

12.

Winkel TA, Schouten O, van Kuijk JP et al (2009) Perioperative asymptomatic cardiac damage after endovascular abdominal aneurysm repair is associated with poor long-term outcome. J Vasc Surg 50:749–754 (discussion 754) CrossRefPubMed

13.

Schouten O, Lever TM, Welten GM et al (2008) Long-term cardiac outcome in high-risk patients undergoing elective endovascular or open infrarenal abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 36:646–652CrossRefPubMed

14.

Ohrlander T, Dencker M, Dias NV et al (2011) Cardiovascular predictors for long-term mortality after EVAR for AAA. Vasc Med (London, England) 16:422–427CrossRef

15.

McNally MM, Agle SC, Parker FM et al (2010) Preoperative statin therapy is associated with improved outcomes and resource utilization in patients undergoing aortic aneurysm repair. J Vasc Surg 51:1390–1396CrossRefPubMed

16.

Leurs LJ, Visser P, Laheij RJ et al (2006) Statin use is associated with reduced all-cause mortality after endovascular abdominal aortic aneurysm repair. Vascular 14:1–8CrossRefPubMed

17.

Kertai MD, Boersma E, Westerhout CM et al (2004) Association between long-term statin use and mortality after successful abdominal aortic aneurysm surgery. Am J Med 116:96–103CrossRefPubMed

18.

Diehm N, Becker G, Katzen B et al (2008) Statins are associated with decreased mortality in abdominal, but not in thoracic aortic aneurysm patients undergoing endovascular repair: propensity score-adjusted analysis. VASA Zeitschrift fur Gefasskrankheiten 37:241–249CrossRefPubMed

19.

Bruin JL, Baas AF, Heymans MW et al (2014) Statin therapy is associated with improved survival after endovascular and open aneurysm repair. J Vasc Surg 51(1):39–44CrossRef

20.

Mathisen SR, Abdelnoor M (2017) Beneficial effect of statins on total mortality in abdominal aortic aneurysm (AAA) repair. Vasc Med (London, England) 22:406–410CrossRef

21.

Keisler B, Carter C (2015) Abdominal aortic aneurysm. Am Fam Phys 91:538–543

22.

Liao JK (2005) Effects of statins on 3-hydroxy-3-methylglutaryl coenzyme a reductase inhibition beyond low-density lipoprotein cholesterol. Am J Cardiol 96:24f–33fCrossRefPubMedPubMedCentral

23.

Tousoulis D, Psarros C, Demosthenous M et al (2014) Innate and adaptive inflammation as a therapeutic target in vascular disease: the emerging role of statins. J Am Coll Cardiol 63:2491–2502CrossRefPubMed

24.

Gray C, Goodman P, O’Malley MK et al (2014) Statins promote residual aneurysm sac regression following endovascular aortic aneurysm repair. Vasc Endovasc Surg 48:111–115CrossRef

25.

Pini R, Faggioli G, Mascoli C et al (2015) Influence of statin therapy on type 2 endoleak evolution. Ann Vasc Surg 29:1167–1173CrossRefPubMed

26.

Karrowni W, Dughman S, Hajj GP et al (2011) Statin therapy reduces growth of abdominal aortic aneurysms. J Investig Med 59:1239–1243CrossRefPubMedPubMedCentral

27.

Schouten O, van Laanen JH, Boersma E et al (2006) Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur J Vasc Endovasc Surg 32:21–26CrossRefPubMed

28.

Periard D, Guessous I, Mazzolai L et al (2012) Reduction of small infrarenal abdominal aortic aneurysm expansion rate by statins. VASA Zeitschrift fur Gefasskrankheiten 41:35–42CrossRefPubMed

29.

Mani K, Bjorck M, Lundkvist J et al (2009) Improved long-term survival after abdominal aortic aneurysm repair. Circulation 120:201–211CrossRefPubMed

Title: Effect of Statin Therapy on Survival After Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis
Authors: Qun Huang
Han Yang
Qiuning Lin
Ming Hu
Yuanbiao Meng
Xiao Qin
Publication date: 01-10-2018
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 10/2018
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4586-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effect of Statin Therapy on Survival After Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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