Statin use, development of sarcopenia, and long-term survival after endovascular aortic repair

• Published in: Journal of vascular surgery Vol. 74; no. 5; pp. 1651 - 1658.e1
• Main Authors: Lindström, Iisa, Protto, Sara, Khan, Niina, Väärämäki, Suvi, Oksala, Niku, Hernesniemi, Jussi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021
• Subjects: Abdominal aortic aneurysm; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Computed tomography; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Finland; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Male; Predictive Value of Tests; Psoas muscle; Psoas Muscles - diagnostic imaging; Psoas Muscles - drug effects; Retrospective Studies; Risk Assessment; Risk Factors; Sarcopenia; Sarcopenia - chemically induced; Sarcopenia - diagnostic imaging; Sarcopenia - mortality; Statin medication; Surgery; Survival; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Finland; Psoas muscle; Sarcopenia; Statin medication; Computed tomography; Survival; Abdominal aortic aneurysm
• ISSN: 0741-5214; 1097-6809; 1097-6809
• DOI: 10.1016/j.jvs.2021.04.054

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.