Association of ambulatory use of statins and beta-blockers with long-term mortality after vascular surgery

Thomas W. Barrett, Motomi (Tomi) Mori, David De Boer

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: The use of drugs to improve postoperative outcomes has focused on short-term end points and centered on beta-blockers. Emerging evidence suggests statins may also improve postoperative outcomes. Objective: We sought to ascertain if the ambulatory use of statins and/ or beta-blockers was associated with a reduction in long-term mortality after vascular surgery. Design: Retrospective cohort study with a median follow-up of 2.7 years. Setting: Regional multicenter study at Veterans Affairs medical centers. Patients: Three thousand and sixty-two patients presenting for vascular surgery. Measurements: Patients were categorized as using statins or beta-blockers if they filled a prescription for the study drug within 30 days of surgery. Survival analyses, propensity score methods, and stratifications by the revised cardiac risk index (RCRI) were performed. Results: Propensity-adjusted ambulatory use of statins and beta-blockers was associated with a reduction in mortality over the study period compared with nonuse of these medications hazard ratio [HR] = 0.78 [95% CI: 0.67-0.92], P = .0021, and number needed to treat (NNT) = 22 for statins; HR = 0.84 [95% CI: 0.73-0.96], P = .0106, and NNT = 30 for beta-blockers. In addition, for propensity-adjusted use of both statins and beta-blockers compared with neither the HR was 0.56 [95% CI: 0.42-0.74] P <.0001, and NNT was 9. The RCRI confirmed combination statin and beta-blocker use was beneficial at all levels of risk. Use of the combination study drugs by the highest-risk patients was associated with a 33% decrease in mortality after 2 years (P = .0106). Conclusions: The use of ambulatory statins alone or in combination with beta-blockers is associated with a reduction in long-term mortality after vascular surgery, and combination use benefits patients at all levels of risk.

Original languageEnglish (US)
Pages (from-to)241-252
Number of pages12
JournalJournal of Hospital Medicine
Volume2
Issue number4
DOIs
StatePublished - Jul 2007

Fingerprint

Hydroxymethylglutaryl-CoA Reductase Inhibitors
Blood Vessels
Mortality
Numbers Needed To Treat
Propensity Score
Prescription Drugs
Veterans
Drug Combinations
Survival Analysis
Ambulatory Surgical Procedures
Multicenter Studies
Cohort Studies
Retrospective Studies

Keywords

  • Beta-blockers
  • Mortality
  • Statins
  • Vascular surgery

ASJC Scopus subject areas

  • Health Policy
  • Assessment and Diagnosis
  • Care Planning
  • Fundamentals and skills
  • Leadership and Management

Cite this

Association of ambulatory use of statins and beta-blockers with long-term mortality after vascular surgery. / Barrett, Thomas W.; Mori, Motomi (Tomi); De Boer, David.

In: Journal of Hospital Medicine, Vol. 2, No. 4, 07.2007, p. 241-252.

Research output: Contribution to journalArticle

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abstract = "Background: The use of drugs to improve postoperative outcomes has focused on short-term end points and centered on beta-blockers. Emerging evidence suggests statins may also improve postoperative outcomes. Objective: We sought to ascertain if the ambulatory use of statins and/ or beta-blockers was associated with a reduction in long-term mortality after vascular surgery. Design: Retrospective cohort study with a median follow-up of 2.7 years. Setting: Regional multicenter study at Veterans Affairs medical centers. Patients: Three thousand and sixty-two patients presenting for vascular surgery. Measurements: Patients were categorized as using statins or beta-blockers if they filled a prescription for the study drug within 30 days of surgery. Survival analyses, propensity score methods, and stratifications by the revised cardiac risk index (RCRI) were performed. Results: Propensity-adjusted ambulatory use of statins and beta-blockers was associated with a reduction in mortality over the study period compared with nonuse of these medications hazard ratio [HR] = 0.78 [95{\%} CI: 0.67-0.92], P = .0021, and number needed to treat (NNT) = 22 for statins; HR = 0.84 [95{\%} CI: 0.73-0.96], P = .0106, and NNT = 30 for beta-blockers. In addition, for propensity-adjusted use of both statins and beta-blockers compared with neither the HR was 0.56 [95{\%} CI: 0.42-0.74] P <.0001, and NNT was 9. The RCRI confirmed combination statin and beta-blocker use was beneficial at all levels of risk. Use of the combination study drugs by the highest-risk patients was associated with a 33{\%} decrease in mortality after 2 years (P = .0106). Conclusions: The use of ambulatory statins alone or in combination with beta-blockers is associated with a reduction in long-term mortality after vascular surgery, and combination use benefits patients at all levels of risk.",
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AB - Background: The use of drugs to improve postoperative outcomes has focused on short-term end points and centered on beta-blockers. Emerging evidence suggests statins may also improve postoperative outcomes. Objective: We sought to ascertain if the ambulatory use of statins and/ or beta-blockers was associated with a reduction in long-term mortality after vascular surgery. Design: Retrospective cohort study with a median follow-up of 2.7 years. Setting: Regional multicenter study at Veterans Affairs medical centers. Patients: Three thousand and sixty-two patients presenting for vascular surgery. Measurements: Patients were categorized as using statins or beta-blockers if they filled a prescription for the study drug within 30 days of surgery. Survival analyses, propensity score methods, and stratifications by the revised cardiac risk index (RCRI) were performed. Results: Propensity-adjusted ambulatory use of statins and beta-blockers was associated with a reduction in mortality over the study period compared with nonuse of these medications hazard ratio [HR] = 0.78 [95% CI: 0.67-0.92], P = .0021, and number needed to treat (NNT) = 22 for statins; HR = 0.84 [95% CI: 0.73-0.96], P = .0106, and NNT = 30 for beta-blockers. In addition, for propensity-adjusted use of both statins and beta-blockers compared with neither the HR was 0.56 [95% CI: 0.42-0.74] P <.0001, and NNT was 9. The RCRI confirmed combination statin and beta-blocker use was beneficial at all levels of risk. Use of the combination study drugs by the highest-risk patients was associated with a 33% decrease in mortality after 2 years (P = .0106). Conclusions: The use of ambulatory statins alone or in combination with beta-blockers is associated with a reduction in long-term mortality after vascular surgery, and combination use benefits patients at all levels of risk.

KW - Beta-blockers

KW - Mortality

KW - Statins

KW - Vascular surgery

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