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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003EThe VISION study examined the association of preoperative statin use with 30-day frequency of cardiovascular complications. Data from over 7000 patients who received noncardiac surgery indicate the potential value of preoperative statin use, which was associated with lower 30-day risk of all-cause mortality and myocardial injury at 30 days. VISION was an observational study. Randomized controlled trials are needed.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiovascular complications\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Enoncardiac surgery\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Estatins\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EVISION\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003E30-day outcome\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EData from the prospective, international, cohort VISION study [Berwanger O et al. \u003Cem\u003EEur Heart J.\u003C\/em\u003E 2015] of patients undergoing noncardiac surgery have indicated the value of preoperative statin use to lessen cardiovascular (CV) complications, according to Otavio Berwanger, MD, Research Institute-Cardiac Hospital, S\u00e3o Paulo, Brazil.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EOf the estimated 200 million adults worldwide who receive noncardiac surgery every year, \u2265\u200510 million experience CV complications within 30 days. Observational data and findings of small randomized controlled trials have implicated statin use before surgery in the reduced risk of such CV events. More robust data are needed, and the paucity of data was the impetus for the VISION study.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EVISION was a 12-center, 8-country observational study. Consecutive patients \u2265\u200545 years old undergoing noncardiac surgery at the participating centers were enrolled. The total enrollment of over 40\u2005000 yielded a cohort that was a representative sample of patients undergoing noncardiac surgery. Early findings from the first 15\u2005478 patients linked postoperative elevated troponin with 30-day mortality in the patient population [Devereaux PJ et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EData from 7337 patients\u20142845 who received statin preoperatively and 4492 who did not\u2014were presented. Baseline characteristics between the 2 groups were similar in the propensity-matched population, with the exception of slightly higher prevalence of coronary artery disease, peripheral vascular disease, diabetes, and the preoperative use of aspirin and angiotensin-converting enzyme\/angiotensin II receptor blocker inhibitors among statin users.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe prevalence of urgent (2.2%), emergent (8%), orthopedic (about 26%), and low-risk (36%) surgery was similar between the 2 groups.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe primary outcome was all-cause mortality, myocardial injury after noncardiac surgery, or stroke at 30 days. Secondary outcomes included peak troponin related to myocardial ischemia, myocardial infarction, CV and non-CV death, and stroke. Subgroup analyses assessed the effects of statin on CV events at 30 days.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EAfter propensity matching, preoperative use of statin was associated with a significantly lower risk at 30 days of the primary outcome (RR, 0.83; 95% CI, 0.73 to 0.95; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.007). Secondary outcomes were also significantly lower with statin use, including all-cause mortality (RR, 0.58; 95% CI, 0.40 to 0.83; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.003) and cardiovascular mortality (RR, 0.42; 95% CI, 0.23 to 0.76; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.004).\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EThe matched statin group had a lower risk of the primary outcome (RR, 0.82; 95% CI, 0.68 to 0.98). Survival at 30 days was also significantly greater in matched patients preoperatively treated with statins (HR, 0.57; 95% CI, 0.47 to 0.69; \u003Cem\u003EP\u2005\u003C\/em\u003E=\u2005.004). Subgroup analyses revealed a potential preferential benefit of preoperative statin use in 1973 patients with diabetes relative to 5364 patients without diabetes (RR, 0.71; 95% CI, 0.56 to 0.91 vs RR, 0.92; 95% CI, 0.77 to 1.09; \u003Cem\u003EP\u003C\/em\u003E\u003Csub\u003Einteraction\u003C\/sub\u003E\u003Cem\u003E\u2005\u003C\/em\u003E=\u2005.04).\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003ELimitations of VISION included its observational design (statin use clearly might be a surrogate for another confounder related to 30-day outcome when the associated risk for survival is substantially lower than the primary outcome), the presence of some baseline differences, and the lack of data on statin type\/dose, liver function, and muscle function.\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ENonetheless, the data from this large cohort of patients undergoing noncardiac surgery indicate the potential value of statin use before surgery in lessening CV complications 30 days postoperatively. Dr Berwanger noted that these findings need to be confirmed in large perioperative randomized controlled trials.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/28_suppl_1\/7.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlfwp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}