By Duane Graveline, M.D., M.P.H.
As if my years of study, the writing of my book Lipitor, Thief of Memory dealing specifically with the cognition disturbances of statins, hundreds of e-mail messages from statin victims with cognitive loss and my writing of nearly one hundred essays relevant to the subject have not said enough, the Canadian Medical Association Journal published its own exposé of this subject.
Donald A. Redelmeier MD and others in their paper: 'Delerium after elective surgery among elderly patients taking statins,' reported the results of a massive study involving 284,158 consecutive patients in Ontario aged 65 years and older who were admitted for elective surgery.
They found 7% of the patients were taking statins. Overall, 3195 patients experienced postoperative cognitive disturbance. The rate was much higher among patients taking statins than among those not taking statins. They did not observe an increased risk of delirium with 20 other cardiac or non-cardiac medications.
They defined delirium as an acute change in mental status that is worrisome to patients and families, especially after elective surgery. This condition may contribute to delays in extubation ( removing a breathing tube ) a prolonged need for intensive care, increased risk of nosocomial infections (infections resulting from in-hospital treatment) and about a 1-week rise in total length of stay in hospital for the average patient.
Delirium also disrupts many specific aspects of care, including the administration of medications, treatment of wounds, physiotherapy, nutrition, hygiene, discharge planning and dignity. The management of delirium is awkward and may lead to a cascade of nonspecific testing and sedation, with an average net increase in hospital costs of $2500 per patient. In some cases, the delirium never completely disappears, and the patient is left with a degree of permanent disability.
In attempting to explain this effect of statin drugs, the authors seemed completely unaware of the work of Pfrieger on glial cell inhibition by statins and focused primarily on another statin side effect, that of altered nitric oxide synthase, known to be involved in regulation of arterial flow, postulating that these effects can be beneficial for reducing the size of stroke or other long-term neurologic disorders but might predispose patients to delirium after anesthesia.
This interpretation no doubt best serves the author's interest but the great bulk of today's research supports statin associated cholesterol inhibition resulting in failure of formation and function of memory synapses as the primary mechanism for cognitive disturbances.
Clearly the authors wished to avoid any possible negative interpretation. They state, "We caution that our findings do not imply that statins are harmful under normal circumstances. On the contrary, trials involving outpatients show many benefits from long-term statin therapy in cardiovascular care. The implication of our study is that statins, unlike other cardiac medications, might contribute to delirium after elective surgery and can be discontinued temporarily before surgery." In this latter statement the authors have backed themselves into a corner for such a move would risk thrombogenic complications.
Regardless of how the statin lovers massage this, the bottom line is that if you are on a statin during surgery your risk of cognitive complications are much higher.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor