Statins and cardiac surgery

Long-Term Preoperative Atorvastatin or Rosuvastatin Use in Adult Patients before CABG Does Not Increase Incidence of Postoperative Acute Kidney Injury: A Propensity Score-Matched Analysis

Background: Acute kidney injury (AKI) is among the expected complications of cardiac surgery. Statins with pleiotropic anti-inflammatory and antioxidant effects may be effective in the prevention of AKI. However, the results of studies on the efficacy and safety of statins are varied and require further study. Methods: We conducted a retrospective cohort study to evaluate long-term preoperative intake of atorvastatin and rosuvastatin on the incidence of AKI, based on the “Kidney Disease: Improving Global Outcomes” (KDIGO) criteria in the early postoperative period after coronary artery bypass graft surgery (CABG). We performed propensity score matching to compare the findings in our study groups. The incidence of AKI was assessed on day 2 and day 4 after the surgery. Results: The analysis included 958 patients after CABG. After 1:1 individual matching, based on propensity score, the incidence of AKI was comparable both on day 2 after the surgery (7.4%) between the atorvastatin group and rosuvastatin group (6.5%) (OR: 1.182; 95%Cl 0.411–3.397; p = 0.794), and on postoperative day 4 between the atorvastatin group (3.7%) and the rosuvastatin group (4.6%) (OR: 0.723, 95%Cl 0.187–2.792; p = 0.739). Additionally, there were no statistically significant differences in terms of incidence of AKI after 1:1 individual matching, based on propensity score, between the rosuvastatin group and the control group both on postoperative day 2 (OR: 0.692; 95%Cl 0.252–1.899; p = 0.611) and day 4 (OR: 1.245; 95%Cl 0.525–2.953; p = 0.619); as well as between the atorvastatin group and the control group both on postoperative day 2 (OR: 0.549; 95%Cl 0.208–1.453; p = 0.240) and day 4 (OR: 0.580; 95%Cl 0.135–2.501; p = 0.497). Conclusion: Long-term statin use before CABG did not increase the incidence of postoperative AKI. Further, we revealed no difference in the incidence of post-CABG AKI between the atorvastatin and rosuvastatin groups.

Do Statins Induce or Protect from Acute Kidney Injury and Chronic Kidney Disease: An Update Review in 2018

Statins essentially are cholesterol-lowering drugs that are extensively prescribed for primary and secondary prevention of cardiovascular disease. Compelling evidence suggests that the beneficial effects of statins may not only be due to its ability to control cholesterol levels but also due to a pleiotropic cholesterol-independent anti-inflammatory, antioxidant, endothelial-protective and plaque-stabilizing activity. Along this line, statins may also exert acute and long-term effects on renal function. We present a narrative literature review that summarizes arguments in favor of or against the preventive and/or therapeutic use of statins in kidney-related diseases or complications. We also highlight the ongoing controversy regarding statin therapy in chronic and end-stage kidney disease.

The effects of preoperative statins on the incidence of postoperative acute kidney injury in patients undergoing cardiac surgeries

OBJECTIVES

Recent evidence has emphasized multifunctional therapeutic effects of statins on renal protection after cardiac surgeries. We aimed to assess the effects of preoperative administration of statins on lowering the incidence of postoperative acute kidney injury in patients undergoing cardiac surgeries.

METHODS

In a retrospective study, the preoperative, intraoperative and postoperative data of 1064 consecutive patients who underwent different forms of cardiovascular surgeries were reviewed. According to whether patients had received statins preoperatively, the patients were categorized into no statin (n = 620), low-dose statin (n = 262) or high-dose statin (n = 182) administration groups.

RESULTS

No difference was seen in postoperative incidence of acute kidney injury between the three groups (11.1, 9.9 and 11.5%, respectively, P = 0.887). The multivariate logistic regression analysis showed that advanced age [odds ratio (OR) = 1.043, P < 0.001], recent myocardial infarction within 90 days of surgery (OR = 1.935, P = 0.002) and longer intubation time (OR = 1.001, P = 0.001) could predict occurrence of kidney injury after cardiac surgery. The preoperative use of angiotensin converting enzyme (ACE) inhibitor could effectively prevent occurrence of this postoperative event (OR = 0.552, P = 0.008). After adjusting for propensity score only, statin treatment, at low or high doses, was not associated with lower postoperative acute kidney injury (OR = 1.010, P = 0.971 for low dose and OR = 1.108, P = 0.745 for high dose versus no statin). After further adjustment for propensity score, statin treatment with the different dosages was not associated with acute kidney injury (OR = 0.869, P = 0.633 for low dose and OR = 1.051, P = 0.885 for high dose versus no statin).

CONCLUSIONS

Preoperative statin use may not inhibit acute kidney injury after operation.

The differential effects of statins on the metastatic behaviour of prostate cancer

Background:

Although statins do not affect the incidence of prostate cancer (CaP), usage reduces the risk of clinical progression and mortality. Although statins are known to downregulate the mevalonate pathway, the mechanism by which statins reduce CaP progression is unknown.

Methods:

Bone marrow stroma (BMS) was isolated with ethical approval from consenting patients undergoing surgery for non-malignant disease. PC-3 binding, invasion and colony formation within BMS was assessed by standardised in vitro co-culture assays in the presence of different statins.

Results:

Statins act directly on PC-3 cells with atorvastatin, mevastatin, simvastatin (1 μℳ) and rosuvastatin (5 μℳ), but not pravastatin, significantly reducing invasion towards BMS by an average of 66.68% (range 53.93–77.04% P<0.05) and significantly reducing both number (76.2±8.29 vs 122.9±2.48; P=0.0055) and size (0.2±0.0058 mm²vs 0.27±0.012 mm²; P=0.0019) of colonies formed within BMS. Statin-treated colonies displayed a more compact morphology containing cells of a more epithelial phenotype, indicative of a reduction in the migrational ability of PC-3 cells. Normal PC-3 phenotype and invasive ability was recovered by the addition of geranylgeranyl pyrophosphate (GGPP).

Conclusion:

Lipophilic statins reduce the migration and colony formation of PC-3 cells in human BMS by inhibiting GGPP production, reducing the formation and the spread of metastatic prostate colonies.