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Statin therapy is associated with improved survival after endovascular and open aneurysm repair

(2014) JOURNAL OF VASCULAR SURGERY. 59(1). p.39-44
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Organization
Abstract
Background: The relationship between numerous risk factors and perioperative mortality after cardiovascular surgery has been studied extensively. While improved perioperative survival and fewer cardiovascular events have been related to statin therapy, its effect on long-term survival after aneurysm repair remains to be elucidated. The aim of this study is to determine the effect of statin therapy on long-term survival after open and endovascular aneurysm repair and to identify other cardiovascular and patient-related risk factors in this respect. Methods: A post-hoc analysis of a randomized trial comparing open and endovascular abdominal aortic aneurysm repair was performed. In this multicenter trial, 351 patients were randomly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair. Patients who were on lipid-lowering medication at their inclusion in the trial (n = 135) were compared with those who were not (n = 216). Results: During 6 years of follow-up, 118 (33.6%) patients died after randomization. Statin therapy, baseline characteristics, Society for Vascular Surgery/International Society for Cardiovascular Surgery risk factors, aneurysm size, reinterventions, antiplatelet or anticoagulant agents, and b-blockers were used to identify prognostic factors influencing survival. After identification of significant factors in a Kaplan-Meier analysis, a multivariable Cox regression analysis was applied. Statin therapy at inclusion in the trial was independently associated with better overall survival after open or endovascular aneurysm repair (hazard ratio [ HR], 0.5; 95% confidence interval [CI], 0.3-0.8; P = .004). Statins were especially associated with fewer cardiovascular deaths (HR, 0.4; 95% CI, 0.2-0.9; P = .025). Several risk factors were associated with poor survival after open and endovascular aneurysm repair: age > 70 (HR, 3.4; 95% CI, 2.2-5.0; P <.001), a history of cardiac disease at baseline (HR, 1.9; 95% CI, 1.3-2.8; P = .001), and moderate/severe tobacco use (HR, 1.7; 95% CI, 1.2-2.5; P = .004). Gender, aneurysm size, the need for reintervention, pulmonary disease, renal disease, carotid disease, hypertension, diabetes mellitus, antiplatelet or anticoagulant agents, and b-blockers were not significantly associated with impaired long-term survival (P >.05). Conclusions: Despite the limitations of a post-hoc analysis of a prospectively maintained trial, we conclude that statin therapy at the beginning of the trial is independently associated with improved long-term survival after open or endovascular aneurysm repair, while age above 70 years, a history of cardiovascular disease, and tobacco use are associated with decreased long-term survival.
Keywords
ABDOMINAL AORTIC-ANEURYSM, NONCARDIAC VASCULAR-SURGERY, EVAR TRIAL 1, PERIOPERATIVE MORTALITY, RANDOMIZED-TRIAL, REDUCTION, CARDIOVASCULAR EVENTS, OUTCOMES, DISEASE

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MLA
de Bruin, Jorg L et al. “Statin Therapy Is Associated with Improved Survival After Endovascular and Open Aneurysm Repair.” JOURNAL OF VASCULAR SURGERY 59.1 (2014): 39–44. Print.
APA
de Bruin, J. L., Baas, A. F., Heymans, M. W., Buimer, M. G., Prinssen, M., Grobbee, D. E., Blankensteijn, J. D., et al. (2014). Statin therapy is associated with improved survival after endovascular and open aneurysm repair. JOURNAL OF VASCULAR SURGERY, 59(1), 39–44.
Chicago author-date
de Bruin, Jorg L, Annette F Baas, Martijn W Heymans, Mathijs G Buimer, Monique Prinssen, Diederick E Grobbee, Jan D Blankensteijn, for the DREAM Study group, and Frank Vermassen. 2014. “Statin Therapy Is Associated with Improved Survival After Endovascular and Open Aneurysm Repair.” Journal of Vascular Surgery 59 (1): 39–44.
Chicago author-date (all authors)
de Bruin, Jorg L, Annette F Baas, Martijn W Heymans, Mathijs G Buimer, Monique Prinssen, Diederick E Grobbee, Jan D Blankensteijn, for the DREAM Study group, and Frank Vermassen. 2014. “Statin Therapy Is Associated with Improved Survival After Endovascular and Open Aneurysm Repair.” Journal of Vascular Surgery 59 (1): 39–44.
Vancouver
1.
de Bruin JL, Baas AF, Heymans MW, Buimer MG, Prinssen M, Grobbee DE, et al. Statin therapy is associated with improved survival after endovascular and open aneurysm repair. JOURNAL OF VASCULAR SURGERY. 2014;59(1):39–44.
IEEE
[1]
J. L. de Bruin et al., “Statin therapy is associated with improved survival after endovascular and open aneurysm repair,” JOURNAL OF VASCULAR SURGERY, vol. 59, no. 1, pp. 39–44, 2014.
@article{6875088,
  abstract     = {Background: The relationship between numerous risk factors and perioperative mortality after cardiovascular surgery has been studied extensively. While improved perioperative survival and fewer cardiovascular events have been related to statin therapy, its effect on long-term survival after aneurysm repair remains to be elucidated. The aim of this study is to determine the effect of statin therapy on long-term survival after open and endovascular aneurysm repair and to identify other cardiovascular and patient-related risk factors in this respect. 
Methods: A post-hoc analysis of a randomized trial comparing open and endovascular abdominal aortic aneurysm repair was performed. In this multicenter trial, 351 patients were randomly assigned to undergo either open abdominal aortic aneurysm repair or endovascular repair. Patients who were on lipid-lowering medication at their inclusion in the trial (n = 135) were compared with those who were not (n = 216). 
Results: During 6 years of follow-up, 118 (33.6%) patients died after randomization. Statin therapy, baseline characteristics, Society for Vascular Surgery/International Society for Cardiovascular Surgery risk factors, aneurysm size, reinterventions, antiplatelet or anticoagulant agents, and b-blockers were used to identify prognostic factors influencing survival. After identification of significant factors in a Kaplan-Meier analysis, a multivariable Cox regression analysis was applied. Statin therapy at inclusion in the trial was independently associated with better overall survival after open or endovascular aneurysm repair (hazard ratio [ HR], 0.5; 95% confidence interval [CI], 0.3-0.8; P = .004). Statins were especially associated with fewer cardiovascular deaths (HR, 0.4; 95% CI, 0.2-0.9; P = .025). Several risk factors were associated with poor survival after open and endovascular aneurysm repair: age > 70 (HR, 3.4; 95% CI, 2.2-5.0; P <.001), a history of cardiac disease at baseline (HR, 1.9; 95% CI, 1.3-2.8; P = .001), and moderate/severe tobacco use (HR, 1.7; 95% CI, 1.2-2.5; P = .004). Gender, aneurysm size, the need for reintervention, pulmonary disease, renal disease, carotid disease, hypertension, diabetes mellitus, antiplatelet or anticoagulant agents, and b-blockers were not significantly associated with impaired long-term survival (P >.05). 
Conclusions: Despite the limitations of a post-hoc analysis of a prospectively maintained trial, we conclude that statin therapy at the beginning of the trial is independently associated with improved long-term survival after open or endovascular aneurysm repair, while age above 70 years, a history of cardiovascular disease, and tobacco use are associated with decreased long-term survival.},
  author       = {de Bruin, Jorg L and Baas, Annette F and Heymans, Martijn W and Buimer, Mathijs G and Prinssen, Monique and Grobbee, Diederick E and Blankensteijn, Jan D and DREAM Study group, for the and Vermassen, Frank},
  issn         = {0741-5214},
  journal      = {JOURNAL OF VASCULAR SURGERY},
  keywords     = {ABDOMINAL AORTIC-ANEURYSM,NONCARDIAC VASCULAR-SURGERY,EVAR TRIAL 1,PERIOPERATIVE MORTALITY,RANDOMIZED-TRIAL,REDUCTION,CARDIOVASCULAR EVENTS,OUTCOMES,DISEASE},
  language     = {eng},
  number       = {1},
  pages        = {39--44},
  title        = {Statin therapy is associated with improved survival after endovascular and open aneurysm repair},
  url          = {http://dx.doi.org/10.1016/j.jvs.2013.07.026},
  volume       = {59},
  year         = {2014},
}

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