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More harm than good from statins for heart surgery

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Short-term treatment with statins before and after heart surgery does more harm than good, suggests major new research that casts doubt on current guidance.

An international trial, led by the University of Oxford and backed by the British Heart Foundation, concluded that daily doses of statins before and after a heart operation do not benefit patients.

“This study clearly shows that statins should not be given to patients at the time of heart surgery”

Peter Weissberg

However, the treatment does expose people undergoing heart surgery to increased risk of kidney damage, researchers found.

The findings, published in the New England Journal of Medicine, challenge current guidelines recommending a short course of statins to reduce complications such as atrial fibrillation.

The trial, which involved more than 1,900 heart surgery Chinese patients whose data and samples were analysed in Oxford, compared results for those randomly allocated either statins or a placebo.

It found no significant difference between the group taking statins and the control group when it came to atrial fibrillation and signs of heart muscle damage.

However, those taking statins were more likely to suffer acute kidney injury in the wake of surgery with more than a quarter – 24.7% – affected compared to 19.3% of those taking the placebo pill.

The findings are expected to lead to changes in guidelines on statin therapy in heart surgery.

However, experts were keen to stress the new research does not challenge strong evidence that long-term prevention treatment with statins helps reduce the risk of heart attack and stroke.

“Although guidelines currently recommend statins at the time of heart surgery to reduce complications, the evidence was not very strong,” said lead researcher Barbara Casadei, a consultant cardiologist at the John Radcliffe Hospital.

“The results of our large, randomised placebo-controlled trial prove that there are no benefits to taking statins shortly before and after heart surgery to reduce post-operative complications,” she said. “But there is an adverse affect on kidney function.”

“Unfortunately we now know that statins are not the right treatment to minimise AF and heart damage after surgery”

Barbara Casadei

She added: “Unfortunately we now know that statins are not the right treatment to minimise atrial fibrillation and heart damage after surgery.”

The research was funded by the British Heart Foundation, the European Commission’s European Network for Translational Research in Atrial Fibrillation, the National Institute for Health Research-funded Oxford Biomedical Research Centre, plus a small unrestricted grant from drugs firm AstraZeneca.

“This study clearly shows that statins should not be given to patients at the time of heart surgery in an attempt to reduce complications like atrial fibrillation,” said British Heart Foundation medical director Professor Peter Weissberg.

“But the study does not negate the wealth of evidence showing that long-term statin treatment reduces the risk of future heart attacks and strokes,” he said.

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