Effect of lipid-modifying drug therapy on survival after abdominal aortic aneurysm repair

• Published in: Journal of vascular surgery 2013-08, Vol.58 (2), p.355-363
• Main Authors: Parmar, Gaurav M., MD, MPH, Lowman, Bruce, MD, Combs, Bart R., MD, Taylor, Steve M., MD, Patterson, Mark A., MD, Passman, Marc A., MD, Jordan, William D., MD, FACS
• Format: Article
• Language: English
• Subjects: African Americans; Aged; Aged, 80 and over; Alabama - epidemiology; Aortic Aneurysm, Abdominal - ethnology; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Chi-Square Distribution; Comorbidity; Dyslipidemias - drug therapy; Dyslipidemias - ethnology; Dyslipidemias - mortality; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; European Continental Ancestry Group; Female; Humans; Hypolipidemic Agents - therapeutic use; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Proportional Hazards Models; Registries; Risk Assessment; Risk Factors; Surgery; Time Factors; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2013.01.036

Background Lipid-modifying drug therapy (LMDT) is recommended in all patients having coronary or noncoronary atherosclerotic disease. However, the effect of LMDT after abdominal aortic aneurysm (AAA) repair, especially in the absence of other atherosclerotic manifestations, is unclear. We examined the distribution of prevalence of LMDT among patients undergoing AAA repair and its effect on survival in the presence and absence of other atherosclerotic diseases. Methods We identified patients treated at University of Alabama at Birmingham between 1985 and 2010 who had a prior AAA repair. Information was collected from health system medical charts, medical communication, and national death indices. We assessed the predictors of prevalence of LMDT by univariate analysis using t -test for continuous and χ2 test for categorical variables, and then performed multivariate logistic regression. The survival was determined using Kaplan-Meier plots, and adjusted hazard ratios were calculated using Cox proportion regression. Results A total of 2063 patients underwent AAA repair procedure. Of these, 9% were African-American, and 20% were female. Thirty-five percent received LMDT, and 32% died during the follow-up period of up to 240 months. Significant predictors for being on LMDT included white race (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.2), presence of other atherosclerotic disease or diabetes (OR, 2.4; 95% CI, 1.9-3.0), hypertension (OR, 4.0; 95% CI, 3.1-5.2), smoking (OR, 1.6; 95% CI, 1.2-2.1), and endovascular AAA repair (OR, 1.9; 95% CI, 1.5-2.3). LMDT was associated with improved survival (hazard ratio, 0.6; 95% CI, 0.5-0.8) after controlling for traditional risk factors, diabetes, and other atherosclerotic diseases. Conclusions LMDT after AAA is associated with an increased survival compared with patients who were not using drug therapy for dyslipidemia. Aggressive management of dyslipidemia should be considered in all patients undergoing AAA repair irrespective of other atherosclerotic disease status and risk factor profile.