A Risk Stratification Analysis of ASCVD Events Post-Statin Discontinuation in Bariatric Surgery Patients

OBJECTIVES: To ascertain the risk of ASCVD events following statin cessation after bariatric surgery and to delineate the variance in outcomes between primary and secondary prevention cohorts.

METHODS: TriNetX database, encompassing electronic medical records from 69 U.S. healthcare institutions, spanning 2012 to 2021 was used. Using a retrospective cohort design, patients aged ≥18 years who underwent bariatric surgery and were concurrently on statin therapy were selected. Discontinuation was defined as a 90-day lapse after the last statin prescription. Patients were categorized as "primary" or "secondary" prevention based on their ASCVD history. The primary outcome was the occurrence of an ASCVD event post-statin cessation. Multivariable Cox proportional hazards models discerned factors influencing this outcome.

RESULTS: Of the 453 statin users who underwent bariatric surgery, 332 (73.1%) were in the primary prevention group and 121 (26.7%) in the secondary prevention group. At one-year post-surgery, ASCVD event-free rates were 93% for primary and 68% for secondary prevention groups. Primary prevention patients showed an 82% reduced risk of post-statin cessation ASCVD events than secondary prevention patients (HR, 0.181; 95% CI, 0.119-0.274). Additionally, Hispanic/Latino patients had heightened post-statin cessation ASCVD risks compared to non-Hispanic/Latino peers.

CONCLUSIONS: Post-bariatric surgery statin discontinuation can pose significant risks, especially for those with ASCVD history and certain demographic groups, like those over 40 with diabetes. Ethnic disparities in outcomes necessitate individualized, equitable healthcare strategies. Optimal decisions about statin cessation necessitate comprehensive evaluations of cardiovascular determinants, with future research crucial to refine therapeutic approaches based on these insights.