Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland.
J Vasc Surg. 2021 Nov;74(5):1651-1658.e1. doi: 10.1016/j.jvs.2021.04.054. Epub 2021 May 19.
Statin therapy, associated with improved short-term survival after treatment of abdominal aortic aneurysms, may also predispose to muscle side effects. Evidence on statin-related sarcopenia is limited mainly to muscle function, and it is subject to several sources of bias. In the long term, postoperative development of sarcopenia is linked to mortality after endovascular repair (EVAR). We investigated statin use and long-term postoperative mortality after EVAR in relation to objective measurable markers of sarcopenia (psoas muscle surface area and density).
Altogether 216 abdominal aortic aneurysm patients treated with EVAR between 2006 and 2014 at Tampere University Hospital (Finland) were retrospectively studied. Psoas muscle parameters at the L3 level were evaluated from baseline and mainly 1- to 3-year follow-up computed tomography studies. Cox regression was used to study the association between statin medication, psoas muscle changes, and all-cause mortality.
The majority of patients were male (87%), and the mean age was 77.7 years (standard deviation, 7.4). The median duration of follow-up was 6.3 years (interquartile range, 3.5) with a total mortality of 54.2% (n = 117). Regardless of a higher burden of comorbidities, statin users (n = 119) had lower mortality when compared with nonusers (multivariable hazard ratio [HR]: 0.69, 95% confidence interval: 0.48-0.99, P = .048). Furthermore, statin use was not associated with inferior muscle parameter values, and the relative change in psoas muscle area was actually lower in statin users compared with nonusers (-15.7% and -21.1%, P < .046).
Statin use is associated with lower long-term mortality among patients undergoing EVAR without predisposing to increased sarcopenia.
他汀类药物治疗与腹主动脉瘤治疗后短期生存率的提高有关，但也可能导致肌肉副作用。关于他汀类药物相关的肌肉减少症的证据主要限于肌肉功能，且受到多种来源的偏倚影响。从长远来看，血管内修复（EVAR）术后肌肉减少症的发展与死亡率相关。我们研究了 EVAR 术后他汀类药物的使用与长期死亡率与肌肉减少症的客观可测量标志物（腰大肌表面面积和密度）之间的关系。
回顾性研究了 2006 年至 2014 年在坦佩雷大学医院（芬兰）接受 EVAR 治疗的 216 例腹主动脉瘤患者。从基线和主要的 1 至 3 年 CT 随访研究中评估 L3 水平的腰大肌参数。Cox 回归用于研究他汀类药物、腰大肌变化与全因死亡率之间的关系。
大多数患者为男性（87%），平均年龄为 77.7 岁（标准差为 7.4）。中位随访时间为 6.3 年（四分位距 3.5），总死亡率为 54.2%（n=117）。尽管合并症负担较高，但与非使用者相比，他汀类药物使用者（n=119）的死亡率较低（多变量风险比[HR]：0.69，95%置信区间：0.48-0.99，P=0.048）。此外，他汀类药物的使用与肌肉参数值的降低无关，并且与非使用者相比，他汀类药物使用者的腰大肌面积的相对变化实际上更低（-15.7%和-21.1%，P<0.046）。
在接受 EVAR 的患者中，他汀类药物的使用与较低的长期死亡率相关，而不会导致肌肉减少症的增加。
