Cholesterol Drugs May Raise Post-Op Delirium Risk

MONDAY, Sept. 22 (HealthDay News) — People who are taking cholesterol-lowering statin drugs — which include Crestor, Lipitor, Pravachol and Zocor — are more likely to suffer delirium after surgery, a Canadian study indicates.

Delirium is a common, and commonly neglected, experience for older people after any sort of surgery, according to study lead author Dr. Donald A. Redelmeier, professor of medicine at the University of Toronto.

“It’s quite striking how some people are unable to recognize family members and don’t know where they are,” Redelmeier said. “It is sometimes prolonged and severe.”

His team published its findings in the Sept. 23 issue of the Canadian Medical Association Journal.

The study included more than 284,000 people, 65 years of age and older, who had surgery in Ontario hospitals. The researchers reported that the incidence of delirium was 1 out of every 90 patients, but it was 30 percent more likely to occur in those taking statins before surgery.

These statistics are almost certainly too low, however, because “there is no question that delirium is often overlooked by the surgeon or family members or even the patient himself,” Redelmeier said.

His estimate is that delirium occurs after about 10 percent of all surgical procedures, and that the incidence is 13 percent among people taking statins.

Redelmeier said he looked for a possible link between statins and post-op delirium, because “all clinical trials of statins focus on otherwise healthy outpatients under normal circumstances. Whereas, from my work in hospitals, I have found that medications that are safe under normal circumstances might not be safe at the time of surgery.” Blood-thinning medications such as Coumadin, as well as sleeping pills, are other examples of drugs that raise delirium risks, he said.

Statins might increase the risk of delirium by shunting blood away from the brain to the heart, the report proposed. “It is plausible, but there are no biological data to support it,” said one expert, Dr. Edward R. Marcantonio, associate professor of medicine at Harvard Medical School and the author of an accompanying editorial.

Marcantonio was also cautious about stopping statin therapy before surgery. “Before making a change in clinical management, I usually like to see stronger evidence in doing so,” he said.

Marcantonio cited other factors that argued against stopping statins. “We certainly don’t know the effect of taking patients off these drugs on outcomes other than delirium, such as cardiovascular conditions,” he said. “They may have cardiovascular benefits above and beyond their lipid-lowering effects.”

And, Marcantonio said, “There is always the risk of the drug never getting restarted.”

Redelmeier has no such doubts. An internist, he does not do surgery himself but is often called in for consultation by surgeons. “I take the position that a brief interruption, for one or two days prior to surgery, is extremely simple, and if desired, you could restart the statin right there in the recovery room after surgery, so you get protection without any interaction with anesthetics,” he reasoned.

More study is needed to settle the issue, Marcantonio said, and such a study would use better tools than those in the new report. Delirium has been underreported in the past because of reliance on reviews of medical records “or even abstraction into databases,” he said. “One of the real advances has been development of interview tools to enable assessment of delirium in a reliable way.”

Marcantonio has done such studies himself. “It is an expanding area of research — ongoing studies of delirium where data may be available to do this sort of evaluation,” he said. “Certainly, such a study is doable, perhaps within a couple of years.”

What Puts You at Risk for High Cholesterol?

Blood cholesterol is a risk factor for coronary artery disease and heart attack, so reducing your risk of high cholesterol is a worthy goal. However, the next time you brag that your cholesterol is nice and low—or lament that your number is in the mid-200s—know this: "Your total cholesterol is a pretty meaningless number," says Maureen Mays, MD, a preventive cardiologist and lipid specialist at Oregon Health & Science University in Portland. "Not only does the general public not know this, some doctors don't either."

Here's why "the number" is so misleading. Total cholesterol is calculated by adding LDL (bad cholesterol), HDL (good cholesterol), and one-fifth of your triglyceride total. "We have been using this formula of adding a bad thing to a good thing and factoring in one-fifth of a bad thing, and it's not useful," Dr. Mays says.

That's one reason 50% of people who have a heart attack have normal cholesterol readings.

What Stress Tests Reveal About Your Heart Health

Your doctor can't tell how well your heart is working until it's put to the test. If you have heart disease—or if you're at risk—your doctor may want to examine your heart during exercise. The stress test can spot hidden problems with your heart and help determine how much exercise you can safely handle.

Kit Cassak, 63, of Scottsdale, Ariz., had had a regular electrocardiogram (ECG or EKG) test in the past, but when she experienced shortness of breath and chest, arm, and jaw pain during physical activity, her doctor referred her to a cardiologist for a stress test. "They hooked up these different electrodes pretty much like an ECG, and they got me to walk on this treadmill, which I'd done during my normal workouts. In less than two minutes they started to see something on their screens and I told them I was feeling symptoms," she says. The cardiologist immediately stopped the test and referred her to the hospital for an angiogram to look for blockages in her blood vessels. The test determined that she needed open-heart surgery.

What to Expect From an Echocardiogram

Doctors use ultrasound to detect a baby's first heartbeat, but it can also detect heart problems. An echocardiogram (ECG, EKG, or "echo" for short) uses ultrasound (high-frequency sound waves) to map the structure and functioning of the heart, and to uncover defects in the heart valves and chambers. The procedure is simple and painless.

How an "echo" works

You will lie on your back or on your left side on a bed or table. Small metal discs (electrodes) will be taped to your arms and legs to record your heart rate during the test. For more information, see the medical test Electrocardiogram.

A small amount of gel will be rubbed on the left side of your chest to help pick up the sound waves. A small instrument (transducer) which looks like a microphone, is pressed firmly against your chest and moved slowly back and forth. This instrument sends sound waves into the chest and picks up the echoes as they reflect off different parts of the heart. The echoes are sent to a video monitor that records pictures of your heart for later viewing and evaluation. The room is usually darkened to help the technician see the pictures on the monitor.

At times you will be asked to hold very still, breathe in and out very slowly, hold your breath, or lie on your left side. The transducer is usually moved to different areas on your chest that provide specific views of your heart.

The test usually takes from 30 to 60 minutes. When the test is over, the gel is wiped off and the electrodes are removed.

What Tests Can and Can’t Reveal About Your Heart

Whether they’re trying to diagnose a problem or measure your progress, doctors have many ways to examine your heart. Tests may be as simple as a stethoscope exam to listen for an irregular heart rate, or as sophisticated as a three-dimensional computerized scan to get a clear image of your heart.

No matter how much technology is involved, no single test gives a complete picture of a patient’s risk for heart disease. Symptoms, age, lifestyle, health history, and gender all reveal important clues about a patient’s heart health.

Women may need different tests
And because women often experience heart disease differently from men, doctors are becoming more aware that diagnostic tests should be used differently for women and men, says C. Noel Bairey Merz, MD, medical director of the Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles. Whether you’re a man or a woman, don’t hesitate to tell your doctor—and see a cardiologist if necessary—if you think you might be at risk for heart disease.