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Published on 21 June 2007

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Study queries perioperative heart drugs

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The use of beta-blockers and statins to prevent heart complications during surgery is called into question in this week’s BMJ.

Globally, some 100 million adults have noncardiac surgery each year. Around 1% are at risk of cardiac complications, and about one in four will die each year. Beta-blockers and statins are regularly given to patients perioperatively to help lower blood pressure and prevent such complications.

But a research team led by Professor Stephen Bolsin of Melbourne University, Australia, now warns that the benefit of using these drugs at this time remains unclear.

The team cites several large international studies that found no benefit from perioperative beta-blockers.

Two studies from Denmark and the UK reported no reduction in mortality or incidence several other serious complications, such as heart attack, heart failure and stroke 30 days after surgery in patients receiving beta-blockers. Another study found no benefit six months after surgery, and a trial currently under way has so far not reported any beneficial effects.

However, all studies did report significantly higher rates of important side-effects with beta-blockers, including bradycardia and hypotension. This has led to calls to examine the widespread use of perioperative beta-blocking drugs.

Like beta-blockers, statins have also been advocated to reduce the risk of perioperative cardiac complications, the authors write. Nonrandomised trials suggest that statins confer benefit, but the evidence remains weak, and to demonstrate a strong overall survival benefit would require a “gold-standard” randomised controlled trial of more than 12,000 patients.

The benefits of statins in reducing cardiac complications in the general population and in high-risk patients are well known, but robust evidence to confirm these drugs’ value in routine perioperative use has not been published, the researchers say.

They suggest patients already receiving beta-blockers or statins before surgery should continue with treatment. But no patient should start taking statins or beta-blockers in the perioperative period specifically to reduce the likelihood of perioperative cardiac events.

BMJ 2007;334:1283-4

 



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