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Questions over drugs to prevent heart complications during surgery
June 25, 2007ß blockers and statins in non-cardiac surgery
The use of drugs to prevent heart complications during surgery is called into question in this week's BMJ.
Globally, about 100 million adults have non-cardiac surgery (ie. on any part of the body other than the heart) each year. Around 1% are at risk of cardiac complications, such as heart attacks and strokes, and about one in four will die each year.
Two types of drugs - ß blockers and statins - are regularly given to patients to prevent such complications. They are given shortly before, during, or after surgery (the perioperative stage) to help lower blood pressure
But doctors in Australia now warn that the benefit of using these drugs at this time remains unclear.
They cite several large international studies that found no benefit from perioperative ß blockers.
Two studies from Denmark and the UK reported no reduction in death or several other serious complications, such as heart attack, heart failure, and stroke 30 days after surgery in patients receiving ß blockers. Another study found no benefit six months after surgery, and a trial currently underway has so far not reported any beneficial effects.
However, all studies did report significantly higher rates of important side effects with ß blockers, including slow heart beat (bradycardia) and very low blood pressure (hypotension). This has led to calls to examine the widespread use of perioperative ß blocking drugs.
Like ß blockers, statins have also been advocated to reduce the risk of perioperative cardiac complications, write the authors. Non-randomised trials suggest that statins confer benefit, but the evidence remains weak, and to prove a strong overall survival benefit would require a 'gold-standard' randomised controlled trial of more than 12,000 patients.
The benefits of statins in reducing cardiac complications in the general population and high risk patients are well known, but robust evidence to confirm that these drugs are valuable in routine perioperative use has not been published, they say.
So, on the basis of the evidence currently available, what should practising clinicians do"
They suggest that patients already receiving ß blockers or statins before surgery should continue with treatment. But no patient should start taking statins or ß blockers in the perioperative period specifically to reduce the likelihood of perioperative cardiac events.
BMJ-British Medical Journal
Two types of drugs - ß blockers and statins - are regularly given to patients to prevent such complications. They are given shortly before, during, or after surgery (the perioperative stage) to help lower blood pressure
But doctors in Australia now warn that the benefit of using these drugs at this time remains unclear.
They cite several large international studies that found no benefit from perioperative ß blockers.
Two studies from Denmark and the UK reported no reduction in death or several other serious complications, such as heart attack, heart failure, and stroke 30 days after surgery in patients receiving ß blockers. Another study found no benefit six months after surgery, and a trial currently underway has so far not reported any beneficial effects.
However, all studies did report significantly higher rates of important side effects with ß blockers, including slow heart beat (bradycardia) and very low blood pressure (hypotension). This has led to calls to examine the widespread use of perioperative ß blocking drugs.
Like ß blockers, statins have also been advocated to reduce the risk of perioperative cardiac complications, write the authors. Non-randomised trials suggest that statins confer benefit, but the evidence remains weak, and to prove a strong overall survival benefit would require a 'gold-standard' randomised controlled trial of more than 12,000 patients.
The benefits of statins in reducing cardiac complications in the general population and high risk patients are well known, but robust evidence to confirm that these drugs are valuable in routine perioperative use has not been published, they say.
So, on the basis of the evidence currently available, what should practising clinicians do"
They suggest that patients already receiving ß blockers or statins before surgery should continue with treatment. But no patient should start taking statins or ß blockers in the perioperative period specifically to reduce the likelihood of perioperative cardiac events.
BMJ-British Medical Journal
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Statins show dramatic drug and cell dependent effects in the brain
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Cholesterol-lowering medicines may be effective against cancer
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Adding ezetimibe to atorvastatin improves lipid control
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Use of statins favors the wealthy, creating new social disparities in cholesterol
Since the introduction of statins to treat high cholesterol, the decline in lipid levels experienced by the wealthy has been double that experienced by the poor.
Women with Atrial Fibrillation Are at Significantly Higher Risk of Stroke and Death Compared to Men and Receive Less Attention
Even though the incidence of atrial fibrillation is higher in men than women, a review of past studies and medical literature completed by cardiac experts at Rush University Medical Center shows that women are more likely than men to experience symptomatic attacks, a higher frequency of recurrences, and significantly higher heart rates during atrial fibrillation, which increases the risk of stroke.
Pre-hospital organization: The first links in the chain of survival for heart attack patients
Mortality rate following a heart attack has fallen by more than 50% in Europe over the past 25 years. However, because only minor advances in the medical treatment of AMI are expected over the next decade, it is through organisational changes in the pre-hospital phase that mortality rate will continue this decline to below 5%.
Fatostatin' is a turnoff for fat genes
A small molecule earlier found to have both anti-fat and anti-cancer abilities works as a literal turnoff for fat-making genes, according to a new report in the August 28th issue of the journal Chemistry and Biology, a Cell Press journal.
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