Statins for heart surgery raise risk of kidney injury, warn experts

Statins should not be given to heart surgery patients because they do not protect against arrhythmia and increase the risk of kidney injury, Oxford University has found.

A trial in which 1,922 people scheduled for heart surgery were given a daily dose of a statin in the eight days before the procedure and five days afterwards, or a placebo, has ruled out any clinical benefit from the drug.

Statins were thought to help prevent Atrial Fibrillation (AF), a heart rhythm disorder which can cause shortness of breath and palpitations and also raises the risk of stroke.

But the rates of AF after surgery were not significantly different between the two groups of patients - 21.1 per cent with statin vs. 20.5 per cent with placebo.

The levels of the protein troponin I in the blood, which indicates heart damage, were also not significantly different between the patients taking the statin and those taking the placebo.

As well as showing no benefits, short-term statin treatment in these patients caused an increase in the rate of acute kidney injury after surgery - 24.7 per cent with statin vs. 19.3 per cent with placebo.

British Heart Foundation Professor Barbara Casadei, who led the research at the University of Oxford and is a consultant cardiologist at the John Radcliffe Hospital, said: “Statins have been known to have rapid anti-inflammatory and antioxidant effects for many years. It was important to establish whether such effects would translate into patient benefit in conditions accompanied by a strong inflammatory response, such as heart surgery.

“Although guidelines currently recommend statins at the time of heart surgery to reduce complications, the evidence was not very strong.

"The results of our large randomised placebo-controlled trial conclusively prove that there are no benefits to taking statins shortly before and after heart surgery to reduce postoperative complications but there is an adverse effect on kidney function."

Professor Peter Weissberg, Medical Director at the British Heart Foundation, which helped fund the research, said: “A clinical trial that shows that a drug is ineffective is as important as one that demonstrates benefit. Large, properly conducted clinical trials like this are vital for providing the robust evidence needed to show which treatments are safest and most effective and to inform clinical guidelines.

"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 AF. 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.

“The BHF continues to fund research into reducing the complications from surgery and, with BHF support, Professor Casadei is finding better ways to manage AF. We urgently need better ways of preventing this dangerous heart rhythm disorder that can lead to strokes, and research is helping us to find them.”

The research was published in the New England Journal of Medicine.

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Graham