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Antithrombotic and Lipid Lowering Therapy is Associated With Improved Survival After Vascular Surgery: A Population

Martin Altreuther1, Arne Seternes2, Turi Saltnes3

  • 1Section of Vascular Surgery, Department of Surgery, Trondheim University Hospital, St Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Norwegian Registry for Vascular surgery (NORKAR), Department of Medical Quality Registries, St Olavs hospital, Trondheim University Hospital, Trondheim, Norway.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|October 22, 2023
PubMed

Insights

Combined lipid-lowering drugs and antiplatelet/anticoagulant therapy significantly improved long-term survival after vascular surgery. Patients with lower extremity arterial disease (LEAD) saw the greatest survival benefit from these recommended medications.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacology
  • Public Health

Background:

  • Vascular surgery aims to improve outcomes for conditions like carotid stenosis, abdominal aortic aneurysm (AAA), and atherosclerotic lower extremity arterial disease (LEAD).
  • Optimizing post-operative medical management, including pharmacotherapy, is crucial for long-term patient survival.

Purpose of the Study:

  • To investigate the association between combined lipid-lowering drugs and antiplatelet or anticoagulation therapy and long-term survival following vascular surgery.
  • To assess the impact of recommended medications on survival across different vascular conditions and patient demographics.

Main Methods:

  • Retrospective cohort study of patients undergoing vascular surgery in Norway (2015-2019).
  • Analysis included patients with carotid stenosis, AAA, and LEAD discharged alive.
  • Survival was assessed using Kaplan-Meier analysis and multivariable Cox regression, stratified by treatment and medication adherence.

Main Results:

  • Patients receiving recommended medications (lipid-lowering drugs plus antiplatelets or anticoagulants) upon discharge showed superior survival across all treatment groups.
  • The greatest survival difference was observed in patients with LEAD, with mean survival periods of 4.33 years vs. 3.7 years.
  • Cox regression revealed significantly lower mortality rates for patients on recommended medications for LEAD (HR 0.58) and AAA (HR 0.57).

Conclusions:

  • Recommended medications are associated with improved survival in both sexes and across all vascular surgery treatment groups.
  • The survival benefit was statistically significant for patients with LEAD and AAA, with LEAD patients experiencing the most substantial improvement.
  • Adherence to recommended secondary prophylaxis, particularly for patients with LEAD, is strongly emphasized for enhanced long-term outcomes.
Abstract

Keywords:
Abdominal aortic aneurysmCarotid and peripheral arterial diseaseKaplan–Meier survivalProphylaxis

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