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Preoperative LDL-C and major cardiovascular and cerebrovascular events after non-cardiac surgery
David Rehe1, Varun Subashchandran2, Yan Zhang3
1Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Grossman School of Medicine, New York, NY, USA.
Insights
Lower preoperative LDL-C levels did not reduce the risk of major adverse cardiovascular or cerebrovascular events (MACCE) after noncardiac surgery. Higher LDL-C was unexpectedly associated with fewer MACCE, suggesting current guidelines may need reevaluation for surgical patients.
Area of Science:
- Cardiovascular Medicine
- Perioperative Care
- Lipid Metabolism
Background:
- Preoperative low-density lipoprotein cholesterol (LDL-C) is a key cardiovascular risk factor.
- Its impact on outcomes after noncardiac surgery is not fully understood.
- Current guidelines do not specifically address LDL-C targets in the perioperative setting for noncardiac surgery.
Purpose of the Study:
- To investigate the association between preoperative LDL-C levels and the incidence of major adverse cardiovascular or cerebrovascular events (MACCE) following noncardiac surgery.
- To determine if lower LDL-C concentrations correlate with reduced perioperative cardiovascular risk.
Main Methods:
- Retrospective cohort study involving 43,348 patients undergoing noncardiac surgery.
- Patients were stratified based on preoperative LDL-C levels (<100 mg/dL vs. ≥100 mg/dL).
- MACCE, defined as a composite of myocardial infarction, stroke, myocardial injury, and 30-day mortality, was assessed.
Main Results:
- The overall incidence of perioperative MACCE was 2.5%.
- Higher preoperative LDL-C (≥100 mg/dL) was associated with a significantly lower odds of MACCE compared to lower LDL-C (<100 mg/dL) after multivariable adjustment (aOR 0.783).
- Lower LDL-C concentrations were not linked to a decreased risk of perioperative MACCE.
Conclusions:
- Preoperative LDL-C levels may not be a reliable predictor of perioperative cardiovascular risk in patients undergoing noncardiac surgery.
- The findings suggest that lower LDL-C is not protective and may even be associated with increased risk in this context.
- Further research is warranted to identify and address modifiable risk factors to optimize perioperative outcomes.
Study Objective:
To determine whether preoperative LDL-C concentration affects the risk of perioperative major adverse cardiovascular or cerebrovascular events (MACCE) after noncardiac surgery.
Design:
Single center retrospective cohort study.
Setting:
Hospital (including medical and surgical floor, intensive care unit) and patient disposition location (including the patient's home or any other receiving facility).
Patients:
43,348 non-cardiac surgeries at NYU Langone Health between January 2016 and September 2020.
Interventions:
Patients were grouped based on preoperative LDL-C.
Measurements:
Complete serum lipid panel obtained within one year prior to the date of noncardiac surgery and rate of perioperative MACCE, defined as a composite of in-hospital non-fatal myocardial infarction, in-hospital acute ischemic stroke, myocardial injury after noncardiac surgery, and death from any cause within 30 days of surgery.
Main Results:
Perioperative MACCE occurred in 1093 patients (2.5 %) overall. After multivariable adjustment, odds of MACCE were significantly lower in patients with higher (≥100 mg/dL) versus lower (<100 mg/dL) LDL-C (adjusted odds ratio [aOR] 0.783, 95 % CI, 0.660-0.926]).
Conclusions:
In a large cohort of patients undergoing non-cardiac surgery at a major academic health system in New York City, lower LDL-C concentrations were not associated with a lower incidence of perioperative MACCE. Further investigation into modifiable perioperative cardiovascular risk factors is needed to improve perioperative outcomes.
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