Role of Statins after Endovascular Repair of Abdominal Aortic Aneurysms: A Nationwide Population-Based Study

The role of statins after endovascular abdominal aortic aneurysm repair (EVAR) has not been well established in an Asian context. In this study, the use of statins and their association with long-term health outcomes were evaluated in patients undergoing EVAR using the Korean National Health Insurance Service database. Among the 8893 patients who underwent EVAR from 2008 to 2018, 3386 (38.1%) were on statins prior to the procedure. Patients using statins had a higher prevalence of comorbidities, such as hypertension (88.4% vs. 71.5%), diabetes mellitus (24.5% vs. 14.1%), and heart failure (21.6% vs. 13.1%), compared with non-users (all p < 0.001). After propensity score matching, statin use prior to EVAR was associated with a lower risk of all-cause mortality (HR 0.85, 95% CI 0.78–0.92, p < 0.001) and cardiovascular mortality (HR 0.66, 95% CI 0.51–0.86, p = 0.002). Statin use following EVAR was associated with a lower risk of adverse events, but not significantly so. Patients on statins both preceding and following EVAR had a lower risk of all-cause mortality (HR 0.82, 95% CI 0.73–0.91, p < 0.001) and cardiovascular mortality (HR 0.62, 95% CI 0.44–0.87, p = 0.007), compared with statin non-users. Among Korean patients undergoing EVAR, the persistent use of statins prior to and after the procedure was associated with a lower risk of mortality, compared with non-statin users.

[1]  Jason T. Lee,et al.  Female sex is independently associated with in-hospital mortality after endovascular aortic repair for ruptured aortic aneurysm. , 2021, Annals of vascular surgery.

[2]  Xin Wang,et al.  Statins Reduce Mortality After Abdominal Aortic Aneurysm Repair: A Systematic Review and Meta-analysis. , 2021, Journal of vascular surgery.

[3]  R. Forsythe,et al.  Endovascular repair for abdominal aortic aneurysms , 2021, Heart.

[4]  P. Toth,et al.  Long-term statin persistence is poor among high-risk patients with dyslipidemia: a real-world administrative claims analysis , 2019, Lipids in Health and Disease.

[5]  M. Sabatine,et al.  2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. , 2019, European heart journal.

[6]  Daniel E Forman,et al.  2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. , 2019, Journal of the American College of Cardiology.

[7]  K. Liao,et al.  The influence of statins on aortic aneurysm after operation , 2019, Medicine.

[8]  F. Gani,et al.  Statin intensity and postoperative mortality following open repair of intact abdominal aortic aneurysm , 2018, BJS open.

[9]  H. Eckstein,et al.  Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians: Meta-analysis and Systematic Review. , 2017, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[10]  T. Brown,et al.  Statin Discontinuation, Reinitiation, and Persistence Patterns Among Medicare Beneficiaries After Myocardial Infarction: A Cohort Study , 2017, Circulation. Cardiovascular quality and outcomes.

[11]  W. Henderson,et al.  Association of Perioperative Statin Use With Mortality and Morbidity After Major Noncardiac Surgery , 2017, JAMA internal medicine.

[12]  U. Laufs,et al.  Pleiotropic Effects of Statins on the Cardiovascular System , 2017, Circulation research.

[13]  P. Hider,et al.  Systematic Review and Meta-analysis of Factors Influencing Survival Following Abdominal Aortic Aneurysm Repair. , 2016, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[14]  A. Freyrie,et al.  Influence of statin therapy on type 2 endoleak evolution. , 2015, Annals of vascular surgery.

[15]  L. Zhizhong,et al.  A two‐year follow‐up for Chinese patients with abdominal aortic aneurysm undergoing open/endovascular repair , 2014, Chinese medical journal.

[16]  C. Twine,et al.  Systematic review and meta‐analysis of the effects of statin therapy on abdominal aortic aneurysms , 2011, The British journal of surgery.

[17]  R. Collins,et al.  Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials , 2010, The Lancet.

[18]  A James O'Malley,et al.  Risk prediction for perioperative mortality of endovascular vs open repair of abdominal aortic aneurysms using the Medicare population. , 2009, Journal of vascular surgery.

[19]  J. Blankensteijn,et al.  Statin Use Is Associated with Reduced All-Cause Mortality after Endovascular Abdominal Aortic Aneurysm Repair , 2006, Vascular.

[20]  T. Wilt,et al.  Effectiveness of statin therapy in adults with coronary heart disease. , 2004, Archives of internal medicine.

[21]  J. Parodi,et al.  Transfemoral intraluminal graft implantation for abdominal aortic aneurysms , 1991, Annals of vascular surgery.

[22]  I. A. Gur'ev,et al.  [A self-fixing synthetic blood vessel endoprosthesis]. , 1986, Vestnik khirurgii imeni I. I. Grekova.

[23]  Ashraf Mansour Habib Mansour,et al.  The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm , 2018, Journal of vascular surgery.

[24]  I. Komuro,et al.  Predictors of mortality after emergency or elective repair of abdominal aortic aneurysm in a Japanese population , 2012, Heart and Vessels.

[25]  M. Taskinen,et al.  [ESC/EAS Guidelines for the management of dyslipidaemias]. , 2011, Revista espanola de cardiologia.