Heart Care Info - Heart Disease Prevention & Treatment

The influence of surgery on the onset of symptomatic coronary artery disease

HJ Mc Farlane, L Girdwood, A Bhaskar... - ..., 2012 - Wiley Online Library We speculated that asymptomatic patients undergoing routine surgery might be at higher risk of subsequent cardiac events. We studied 183 534 patients with no prior admission for heart disease, aged 5075 years, admitted electively for one of five operations considered ...

There are a number of important limitations to the study. The groups were not controlled for other major cardiovascular risk factors, such as lipid profiles, smoking, hypertension and diabetes. Although those in the most deprived areas are at increased risk, the health domain of the deprivation index does not specifically include risk factors for cardiovascular disease. Patients in both groups could have been undergoing treatment for coronary artery disease or risk reduction strategies initiated in the community, which would include over the counter statins and aspirin without prior admission to hospital [27]. Some evidence for this may exist in the decreasing risk of mortality between 1997 and 2005. In Scotland, in the period 2000 2009 the incidence of new cases of heart disease reduced by almost a fifth and the number of prescriptions for cardiovascular disease increased by 61%[28]. Hence, the study included a period with changing priorities in public health allied to increases in our understanding of the peri operative management of cardiac disease. The incidence of cancer in both groups remains unknown. We could speculate that the reduced survival benefit in those undergoing upper GI surgery related more to a presumed diagnosis of cancer. Perhaps the major limitation in defining clear conclusions from this study is the nature of the control group, which represented a sample of all other patients admitted electively to hospital. As a result, the control group may have included some patients undergoing other types of major surgery where the procedure presented an increased cardiac risk although the patients themselves may have been low risk.