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Fluvastatin in patients undergoing vascular surgery.

To the Editor: The results of the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography III (DECREASE III) study (Current Controlled Trials number, ISRCTN83738615) reported on by Schouten et al. (Sept. 3 issue)1 should be interpreted carefully. The reduction of cardiac complications observed in the fluvastatin group cannot be generalized to all patients undergoing vascular surgery. Indeed, inclusion criteria required at least 51 points on a prespecified risk index. This requirement excluded 356 patients from the study. In addition, 798 patients who were already receiving statins were excluded; this was probably an initial response to the guidelines on perioperative evaluation from the American College of Cardiology and the American Heart Association which recommended the use of these drugs.2 These guidelines were published after the results of our randomized, controlled trial on this subject.3 In that trial, we found that the use of 20 mg of atorvastatin reduced cardiac events in all patients referred for vascular surgery. Despite the fact that we did not have prespecified risk index as an exclusion criterion, we conclude that the available evidence does not provide support for the use of statins to reduce the risk of cardiac events among all patients.