Further information: Peripheral Arterial Diseases (see p1681), Carotid Artery Intervention (see p1741), and Endovascular Procedures for the Treatment of Peripheral Vascular Disease (see p1755) from Cardiovascular Medicine, 3rd Edn*

Investigators conducted the Dutch Echocardiographic III (DECREASE III) trial [1] to determine whether or not statin therapy could reduce the postoperative incidence of adverse cardiac events in patients undergoing noncardiac, elective vascular surgery. Patients were eligible for this randomized, double-blind, placebo-controlled trial if they had not previously taken a statin, were over 40 years of age, and were scheduled for noncardiac vascular surgery at Erasmus Medical Center between June 2004 and April 2008. The types of surgery included abdominal aortic aneurysm repair, distal aortoiliac reconstruction, lower-limb arterial reconstruction, or carotid-artery endarterectomy. From a total of 497 patients enrolled, 250 patients were assigned to fluvastatin and 247 to placebo a median of 37 days before surgery. The primary end point of the study was the development of myocardial ischemia, either as transient ECG signs of ischemia, release of troponin T, or both within 30 days post-surgery. The secondary end point was the composite of death from cardiovascular causes and nonfatal myocardial infarction (MI).

The primary end point of myocardial ischemia within 30 days post-surgery occurred in 27 (10.8%) of 250 patients in the fluvastatin group, and the secondary end point of cardiovascular death occurred in a total of six patients in the fluvastatin group. The primary end point occurred in 47 (19.0%) of the 247 patients who took placebo. There were 12 patient deaths in the placebo group, and eight were cardiovascular deaths. Although the pathophysiology of perioperative cardiac events is not clear, it is thought that a statin worked for these patients by reducing the risk of atherosclerotic plaque rupture-induced MI by stabilizing unstable coronary plaques.

The authors of this paper concluded that the use of fluvastatin therapy in patients having vascular surgery reduced adverse events postoperatively.

[1] Schouten O, Boersma E, Hoeks SE, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009;361:980-989.

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