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. Journal of Hospital Medicine 2007;2:241–252. © 2007 Society of Hospital Medicine.