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

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.