The Effect of High-dose Statin on Cardiac Biomarkers Following Lower Limb Vascular Surgery: A Randomized Clinical Trial

Abstract

Background: Patients undergoing peripheral vascular surgery frequently present with comorbid cardiovascular disease, where perioperative myocardial ischemia and infarction represent leading causes of morbidity and mortality. Through its plaque-stabilizing properties, atorvastatin may reduce postoperative cardiac complications. Objectives: This study investigated whether preoperative high-dose atorvastatin therapy provides cardioprotective benefits for patients requiring lower limb vascular revascularization. Methods: We conducted a single-center, double-blind, randomized controlled trial at Golestan Hospital (Ahvaz, Iran) between April 2019 and March 2021. Eighty eligible patients were randomly assigned (1:1) via computer-generated allocation concealed in opaque envelopes to receive either high-dose atorvastatin (n = 40) or a conventional dose (control, n = 40). The study maintained triple blinding (participants, surgeons, and assessors). Serial measurements of cardiac biomarkers [troponin I, creatine kinase-MB (CK-MB), creatine phosphokinase (CPK)], renal function (creatinine), and ECG monitoring were performed at 6, 24, and 72 hours postoperatively. Results: Baseline characteristics showed no significant intergroup differences. The atorvastatin group demonstrated significantly lower postoperative levels of troponin I (P < 0.05), CK-MB (P < 0.05), and creatinine (P < 0.05). A transient elevation in CPK levels occurred at 6 hours post-surgery in the treatment group (P < 0.05), which subsequently normalized. These findings support the potential myocardial and renal protective effects of high-dose statin therapy in vascular surgery patients. Conclusions: Perioperative administration of high-dose atorvastatin significantly reduces biochemical markers of cardiac and renal injury following lower extremity vascular procedures. These results suggest statins may improve outcomes in this high-risk surgical population.