Two big arteries carry blood to the brain, and a blockage in one of them is bad news. It's the leading reason for disabling strokes and the third most common cause of death. So operations to clean out the vessel are very commonthere are 160,000 to 180,000 of them every year. But this surgery, done to prevent a stroke, can sometimes cause one. As many as 5 percent of patients will have a stroke or die after the operation, perhaps because part of the blockage, or plaque, breaks loose after all the poking around.
Now new research, released today, shows that people who take statinsthe cholesterol-lowering drugsbefore their surgery cut their rates of stroke afterward to less than a third of the rate in nonstatin users. They had an even bigger reduction in death rates.
"It was an astounding result," says Bruce Perler, chief of vascular surgery at Johns Hopkins Hospital in Baltimore and lead author of the study. "We know statins have beneficial long-term effects, but this was a large, acute one. We think it can make a safe operation even safer."
"I would start a patient on statins a week before surgery, if they could tolerate the drugs," says Roy Greenberg, director of endovascular research at the Cleveland Clinic. "They seem to have plaque-stabilizing benefits and do other good things besides lowering cholesterol."
Perler and his colleagues looked at more than 1,500 people who underwent the surgery, known as a carotid endarterectomy, at the hands of 13 different surgeons. Of these patients, 42 percent had been on statins for at least a week before the operation and had much lower rates of stroke and death following the surgery, Perler reported at the American Medical Association's Science Reporters Conference in Washington, D.C.
Statins have been shown to keep plaques from fragmenting and also may improve the ability of artery walls to expand.
"So the benefit should appear in other approaches to carotid artery repair, such as inserting a stent," says Greenberg, referring to a mesh sleeve slipped into an artery to prop it open. "Whether it's this surgery, or an aneurysm repair, or a vessel bypass operation on the legs, I think statins help."
He does caution that doctors don't know yet what dosage of the drugs produce the best results and that some people can't tolerate them and develop side effects like liver problems and muscle weakness. So statins aren't a wonder pill for everyone. But if more research results like these come in, statins before vessel surgery may become standard operating procedure.