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 w
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