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Perioperative Statin Therapy Reduces Mortality in Normolipidemic Patients Undergoing Cardiac Surgery Muthiah Vaduganathan, Neil J Stone, *Richard Lee, *Edwin C McGee, Jr., *S C Malaisrie, Robert A Silverberg, *Patrick M McCarthyBluhm Cardiovascular Institute, Division of Cardiothoracic Surgery at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL Background: Statins may have pleiotropic effects, independent of their ability to reduce lipid levels. Recent data has suggested that statins improve early survival and cardiovascular outcomes after coronary artery bypass graft surgery. The effectiveness of statin therapy in normolipidemic cardiac surgery patients is presently unclear. Methods: We evaluated 3056 consecutive patients who underwent cardiac surgery between April 2004 and April 2009. Perioperative statin therapy was defined as continued treatment both before (at least 6 months) and after the index surgery (included as a discharge medication). Hyperlipidemia (HL) was defined as a total cholesterol level > 200 within 6 months prior to surgery. Four groups were analyzed: (i) statin-untreated normolipidemics, NL-(n=1052); (ii) statin-treated normolipidemics, NL+ (n=206); (iii) statin-untreated hyperlipidemics, HL- (n=638); (iv) statin-treated hyperlipidemics, HL+ (n=1160). Adjusted hazard ratios (aHR) accounted for patient demographics, known preoperative cardiac risk factors, surgical characteristics and concomitant medications. Mortality was ascertained by retrospective database review and the Social Security Death Index. Survival curves were compared using the log-rank test. Results: Mean follow-up was 2.2 years. Crude rates of 30-day mortality were 3.0% (32/1052), 0% (0/206), 8.0% (51/638), 0.7% (8/1160) for NL-, NL+, HL- and HL+, respectively. Overall all-cause crude mortality rates were 9.6% (101/1052), 3.9% (8/206), 17.2% (110/638) and 6.5% (75/1160) for NL-, NL+, HL- and HL+, respectively (see figure 1 for survival curves). Compared to NL-, the adjusted HRs for all-cause mortality were 0.29 (0.14, 0.62), 1.09 (0.80, 1.48), 0.49 (0.35, 0.69) for NL+, HL- and HL+, respectively. Statin therapy in normolipidemic patients undergoing cardiac surgery independently reduced overall all-cause mortality [aHR 0.34 (0.16-0.71), P=0.004, see figure 2]. Conclusions: Perioperative statin therapy is associated with reduced long-term mortality in patients undergoing cardiac surgery, irrespective of baseline lipid status. This clinical evidence suggests that the beneficial effects of statins may extend beyond their lipid-lowering ability.  
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