Statin plus beta-blocker may together protect against stroke after CABG

Source: MedWire News

Combining a statin with a beta blocker may reduce the risk for stroke after coronary artery bypass surgery, research suggests.

But the retrospective review, which included thousands of patient records, found no protective effect with either drug class alone.

The researchers speculate that the benefits of combined therapy arise from a reduction in atrial fibrillation, although this is queried in editorial accompanying the study in the Annals of Thoracic Surgery.

Investigators from the Montreal Heart Institute in Quebec, Canada, studied 6813 patients who underwent isolated coronary artery bypass grafting (CABG) at their institution between 1995 and 2005 and for whom a complete medication history was available.

Overall, 94 (1.4%) patients experienced stroke in the 30 days after CABG, and this was linked with age, diabetes, hypertension, and carotid disease in univariate analysis.

Denis Bouchard and colleagues report that preoperative use of statins, aspirin, angiotensin-converting enzyme inhibitors, or beta blockers did not individually affect the risk for postoperative stroke.

However, they found suggestions of a "strong protective effect" for stroke with a combination of pre-operative statins plus beta-blocker therapy in multivariate analysis, with an odds ratio of 0.38.

The team says: "One possible mechanism explaining the positive effect of beta-blocker therapy combined with statins in our study could be the reduction in the atrial fibrillation rate� This reduction in the atrial fibrillation rate could act favorably on postoperative stroke rate."

But in an editorial accompanying the study, Justin Schaffer and Steve Singh from Stanford University Medical Center in California, USA, noted that the stroke rate after CABG was not significantly higher in patients with atrial fibrillation than others.

They commented: "Whereas, randomized trials on these medications are unethical given today's knowledge, continuing along Bouchard and colleagues' methodology of linking large clinical and administrative databases, or analyzing The Society of Thoracic Surgeons' database (as has been done for beta-blocker impact) could certainly verify that our current medical management of patients is optimized."