A risk stratification analysis of atherosclerotic cardiovascular disease events post-statin discontinuation in patients who underwent sleeve gastrectomy or Roux-en-Y gastric bypass bariatric/metabolic surgeries.

Autor: Alsuhibani AA; Department of Pharmacy Practice, College of Pharmacy, Qassim University, Qassim, Buraidah, Saudi Arabia; James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH. Electronic address: aa.alsuhibani@qu.edu.sa., Al-Kadi A; Departments of Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, Kingdom of Saudi Arabia; Department of Surgery, Dr. Sulaiman Al-Habib Medical Group, Riyadh, Kingdom of Saudi Arabia. Electronic address: https://twitter.com/Dr.Alkadi., Wigle PR; James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH., Guo JJ; James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH., Lin AC; James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH., Rao MB; University of Cincinnati College of Medicine, Department of Environmental and Public Health Sciences, Cincinnati, OH., Hincapie AL; James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, OH. Electronic address: https://twitter.com/Analuhincapie.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Sep; Vol. 176 (3), pp. 597-604. Date of Electronic Publication: 2024 Jun 19.
DOI: 10.1016/j.surg.2024.05.024
Abstrakt: Background: Cardiovascular disease remains a leading cause of mortality globally, and its prevalence is notably elevated in individuals with obesity. Bariatric surgery is an effective intervention to reduce obesity-related health risks. However, the implications of discontinuing statin therapy, particularly post-bariatric surgery, among those with a history of atherosclerotic cardiovascular disease have yet to be clarified. We aimed to ascertain the risk of atherosclerotic cardiovascular disease events following statin cessation after bariatric surgery and to delineate the variance in outcomes between primary and secondary prevention cohorts.
Methods: The TriNetX database, encompassing electronic medical records from 69 United States healthcare institutions, spanning 2012 to 2021. Using a retrospective cohort design, patients aged ≥18 years who underwent bariatric surgery and were concurrently on statin therapy were selected. Discontinuation was defined as a 90-day lapse after the last statin prescription. Patients were categorized as "primary" or "secondary" prevention based on their atherosclerotic cardiovascular disease history. The primary outcome was the occurrence of an atherosclerotic cardiovascular disease event post-statin cessation. Multivariable Cox proportional hazards models discerned factors influencing this outcome.
Results: Of the 453 statin users who underwent bariatric surgery, 332 (73.1%) were in the primary prevention group and 121 (26.7%) in the secondary prevention group. At 1-year post-surgery, atherosclerotic cardiovascular disease event-free rates were 93% for primary and 68% for secondary prevention groups. Primary prevention patients showed an 82% reduced risk of post-statin cessation atherosclerotic cardiovascular disease events than secondary prevention patients (hazard ratio, 0.181; 95% confidence interval, 0.119-0.274). Additionally, Hispanic/Latino patients had heightened post-statin cessation atherosclerotic cardiovascular disease risks compared to non-Hispanic/Latino peers.
Conclusion: Post-bariatric surgery statin discontinuation can pose significant risks, especially for those with atherosclerotic cardiovascular disease history and certain demographic groups, such as those over age 40 with diabetes. Ethnic disparities in outcomes necessitate individualized, equitable healthcare strategies. Optimal decisions about statin cessation necessitate comprehensive evaluations of cardiovascular determinants, with future research crucial to refine therapeutic approaches based on these insights.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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