Patients who receive statins along with beta-blockers prior to cardiac surgery do better than those given no such medication, according to a new study.
Senior author Peyman Benharash, MD, told Reuters Health by email, “professional society guidelines have mandated the use of beta blockers in patients taking these agents prior to cardiac surgery. Our group, along with others around the globe, is reporting a lack of clear benefit with beta blockers.”
“Interestingly,” he added, “statins, a class of drugs with many beneficial effects other than cholesterol-lowering properties, may reduce the incidence of complications after cardiac surgery when given in combination with beta blockers.”
For their study, online Nov. 18 in JAMA Surgery, Benharash and colleagues at the David Geffen School of Medicine at the University of California, Los Angeles, reviewed data on patients who underwent cardiac surgery at their institution between 2008 and 2014.
More than 1,900 patients met the inclusion criteria. Of these, 22% were treated with beta-blockers alone, 14% received statins alone, 40% were treated with both, and 24% received no treatment.
After adjustment, mortality rates did not differ across all groups. Nor were significant differences seen between the statins alone or beta-blockers alone group in secondary outcome measures such as length of hospital stay and prolonged mechanical ventilation.
However, compared with patients given no treatment, the combination group had significantly lower rates of prolonged hospitalization (adjusted odds ratio [aOR] 0.59), prolonged mechanical ventilation (aOR 0.61), and reoperations for bleeding (aOR 0.43).
The researchers speculate that the underlying mechanism may be that “both classes of medications may reduce the oxidative stress, and beta blockers may reduce the adrenergic surge associated with cardiac surgery.”
They note that the evidence is limited and call for randomized studies “to assess the effects of this combination therapy in larger cohorts.”
Commenting on the findings by email, cardiothoracic surgeon Elmar W. A. Kuhn, MD, told Reuters Health that he considered the paper of “great interest.”
Kuhn, of the Heart Center at the University of Cologne in Germany, noted that “beta blockers and statins have been put into question for patients undergoing cardiac surgery in the past. However, both medications form essential components in the perioperative care of patients especially undergoing myocardial revascularization and might be responsible for substantial improvements in patients’ outcome.”
“Most surprisingly for me,” he concluded, “is that neither beta blockers, nor statins, nor their combination had impact on the incidence of atrial fibrillation since the most commonly described effect of statins is the prevention of postoperative AF.”