Reserves for reducing mortality from cardiovascular diseases in patients after heart and vascular surgery: possibilities of lipid-lowering therapy

Introduction. Statins reduce the risk of recurrence of cardiovascular events and improve the survival of patients with atherosclerosis, including survival in patients after heart and vascular surgery. However, no more than 10% of patients after heart and vascular surgery are in the target range of low-density lipoproteins. The purpose of the study was to conduct a clinical and economic analysis of the intensification of lipid-lowering therapy in patients who underwent heart and vascular surgery. Materials and methods. The total mortality was modeled for 10 years in patients who underwent surgery for heart and vascular diseases in the Russian Federation. Next, the calculations of the number of lives saved and the total number of years of life saved for 1, 5 and 10 years after heart and vascular surgery were carried out. Based on the approximated survival function, the expected number of deaths in the cohort during the 10-year follow-up period was estimated for each group under consideration. The number of lives saved was calculated as the difference between the expected number of deaths in the baseline scenario and in the intervention scenario over the corresponding time horizon. The number of life years saved was defined as the area under the survival curve during the simulation period (10 years). The additional life years saved were calculated as the difference between the results in the intervention scenario and in the baseline scenario. Then, based on the data obtained, a clinical and economic analysis of the expansion of lipid-lowering therapy was carried out by adding rosuvastatin 10–40 mg and ezetimibe 10 mg to the list of vital and essential medicines for secondary prevention after heart and vascular surgery. Results. Intensification of lipid-lowering therapy through the use of high-intensity statins (including rosuvastatin) and their combination with ezetimibe in patients undergoing surgery for heart and vascular diseases will save 17,165 lives within 10 years, which will save 97,553 years of life. An assessment of the economic costs showed that providing ten years of intensive lipid-lowering therapy for patients undergoing heart and vascular surgery would require additional funds in the amount of 14,356.725 million rubles. Conclusion. Expanding the possibilities of secondary prevention after heart and vascular surgery by enhancing lipid-lowering therapy (including rosuvastatin 20–40 mg in combination with ezetimibe) leads to a long-term reduction in postoperative mortality. An increase in costs per patient by an average of 4,046.97 rubles per year will save 97.5 thousand years of life for 10 years. At the same time, the amount of additional costs per saved year of life is significantly lower than the current Russian threshold for willingness to pay per saved year of quality life.

1. Drapkina O.M., Imaeva A. E., Kutsenko V. A. et al. Dyslipidemia in the Russian Federation: population data, associations with risk factors. Cardiovascular Therapy and Prevention. 2023; 22(8S):3791. DOI: 10.15829/1728-8800-2023-3791. (In Russ.).

2. Yusuf S., Hawken S., Ounpuu S. et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the Interheart study): case-control study. Lancet. 2004; 364(9438):937–952. DOI: 10.1016/S0140–6736(04)17018-9.

3. Clinical practice guidelines for Stable coronary artery disease. Russian Journal of Cardiology. 2024; 29(9):6110. DOI: 10.15829/1560-4071-2024-6110. (In Russ.).

4. Golukhova E.Z., Sigaev I.Yu., Keren M. A. et al. Comparison of coronary artery bypass grafting and stenting depending on the clinical and anatomical scenario: data from the retrospective single-center cohort study. Russian Journal of Cardiology. 2025; 30(4):6092. DOI: 10.15829/1560-4071-2025-6092. (In Russ.).

5. Spertus J.A. ISCHEMIA Research Group. Health Status Outcomes with Invasive or Conservative Care in Coronary Disease. N Engl J Med. 2020; 382(15):1408–1419. DOI: 10.1056/NEJMoa1916370.

6. Baigent C., Keech A., Kearney P. M. et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005; 366(9493):1267–1278. DOI: 10.1016/S0140–6736(05)67394-1.

7. Ference B.A., Ginsberg H. N., Graham I. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017; 38(32):2459–2472. DOI: 10.1093/eurheartj/ehx144.

8. Silverman M.G., Ference B. A., Im K. et al. Association Between Lowering LDL–C and Cardiovascular Risk Reduction Among Different Therapeutic Interventions: A Systematic Review and Meta-analysis. JAMA. 2016; 316(12):1289–1297. DOI: 10.1001/jama.2016.13985.

9. Zhang X. Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials. Cardiovasc Ther. 2020: 3987065.

10. Alkhalil M. Effects of intensive lipid-lowering therapy on mortality after coronary bypass surgery: A meta-analysis of 7 randomised trials. Atherosclerosis. 2020; 293:75–78. DOI: 10.1016/j.atherosclerosis.2019.12.006.

11. Ezhov M.V., Bliznyuk S. A., Alekseeva I. A., Vygodin V. A . Prevalence of hypercholesterolemia and statins intake in the outpatient practice in the Russian Federation (ICEBERG study). The Journal of Atherosclerosis and Dyslipidemias. 2017; 4 (29):5–17. (In Russ.).

12. Golukhova E.Z., Keren M. A., Sigaev I. Y. et al. A dataset of annotated data from patients with stable coronary artery disease who underwent myocardial revascularization (coronary artery bypass grafting and coronary stenting), intended for neural network training. Certificate of Database Registration RU2022620223, January 25, 2022. Application No. 2021622974 of December 10, 2021. (In Russ.).

13. Ray K.K., Reeskamp L. F., Laufs U. et al. Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2022; 43(8):830–833. DOI: 10.1093/eurheartj/ehab718.

14. Sergienko I.V., Kurochkina N. S., Prus Yu.A. et al. Hypolipidemic Therapy. Textbook. Moscow: National Medical Research Center of Cardiology named after Academician E. I. Chazov; 2024. 48 p. ISBN 978-593856-824-2. (In Russ.).

15. Pan E., Nielsen S. J., Mennander A. et al. Statins for secondary prevention and major adverse events after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2022; 164(6):1875–1886.e4. DOI: 10.1016/j.jtcvs.2021.08.088.

16. Bokeria L.A., Milievskaya E. B., Pryanishnikov V. V., Yurlov I. A . Cardiovascular Surgery 2023. Diseases and Congenital Anomalies of the Circulatory System. Moscow: NMITS SSH named after A. N. Bakulev; 2024. ISBN 978-5-7982-0464-9. (In Russ.).

17. Wu C., Camacho F. T., Wechsler A. S. et al. Risk score for Predicting Long-Term Mortality after coronary artery bypass graft surgery. Circulation. 2012; 125(20):2423–30. DOI: 10.1161/CIRCULATIONAHA.111.055939.

18. Luo H.D., Teoh L. K., Gaudino M. F. et al. The Asian system for cardiac operative risk evaluation for predicting mortality after isolated coronary artery bypass graft surgery (ASCORE-C). J Card Surg. 2020; 35(10):2574–2582. DOI: 10.1111/jocs.14836.

19. Fagel N.D., Amoroso G., Rabbering T. et al. One-year mortality in NSTEMI patients is unaffected by timing of PCI within the first week of admission: Results of a real-world cohort analysis. Catheter Cardiovasc Interv. 2021; 98(5): E661-E667. DOI: 10.1002/ccd.29873.

20. Regional programs for the fight against cardiovascular diseases. Results of 2023. Available from: https://minzdrav.gov.ru/ministry/natsproektzdravoohranenie/bssz (Date accessed: May 15, 2026). (In Russ.).

21. Liu J.H., Maggard M., Etzioni D., J . O’Connell, What are the 1-year mortality rates for carotid endarterectomy and abdominal aortic aneurysm repair? Journal of Surgical Research. 2003; 114(2):295.

22. Thrane P.G., Olesen K. K.W., Thim T. et al. 10-Year Mortality After ST-Segment Elevation Myocardial Infarction Compared to the General Population. J Am Coll Cardiol. 2024; 83(25):2615–2625. DOI: 10.1016/j.jacc.2024.04.025.

23. Levin S.R., Farber A., Goodney P. P. et al. Five Year Survival in Medicare Patients Undergoing Interventions for Peripheral Arterial Disease: a Retrospective Cohort Analysis of Linked Registry Claims Data. Eur J Vasc Endovasc Surg. 2023; 66(4):541–549. DOI: 10.1016/j.ejvs.2023.07.055.

24. Casanova N., Diaz-Duran C., Nieto L., Llort C., Elosua R., Clara A. Predictive Value of Complete Blood CountDerived Inflammatory Markers for 5-Year Survival After Carotid Endarterectomy: Implications for Practice. Angiology. 2022; 73(7):675–681. DOI: 10.1177/00033197211067581.

25. Quin J.A., Wagner T. H., Hattler B. et al. Ten-Year Outcomes of Off-Pump vs On-Pump Coronary Artery Bypass Grafting in the Department of Veterans Affairs: A Randomized Clinical Trial. JAMA Surg. 2022; 157(4):303–310. DOI: 10.1001/jamasurg.2021.7578.

26. Konttila K.K., Koivula K., Eskola M. J. et al. Poor long-term outcome in acute coronary syndrome in a real-life setting: Ten-year outcome of the TACOS study. Cardiol J. 2021; 28(2):302–311. DOI: 10.5603/CJ.a2019.0037.

27. Katsuki T., Yamaji K., Hiramori S. et al. Ten-year clinical outcomes for patients undergoing lower extremity endovascular interventions. J Vasc Surg. 2020; 72(5):16261635.e3. DOI: 10.1016/j.jvs.2020.02.026.

28. Kragsterman B., Björck M., Lindbäck J. et al . Swedish Vascular Registry (Swedvasc). Long-term survival after carotid endarterectomy for asymptomatic stenosis. Stroke. 2006; 37(12):2886–91. DOI: 10.1161/01.STR.0000248967.44015.88.

29. Koskinas K.C., Siontis G. C.M., Piccolo R. et al. Effect of statins and non-statin LDL-lowering medications on cardiovascular outcomes in secondary prevention: a meta-analysis of randomized trials. European Heart Journal. 2018; 39(14):1172–1180. DOI: 10.1093/eurheartj/ehx566.

30. Gogolashvili N.G., Yaskevich R. A . Effectiveness of lipid-lowering therapy in outpatients with coronary artery disease living in a large industrial center of Eastern Siberia. Cardiovascular Therapy and Prevention. 2021; 20(8):3135. DOI: 10.15829/1728-8800-2021-3135. (In Russ.).

31. Kontsevaya A.N., Drapkina O. M., Balanova Yu.A. et al. Economic burden of cardiovascular diseases in the Russian Federation in 2016. Rational Pharmacotherapy in Cardiology. 2018; 14(2):156–166. DOI: 10.20996/1819-6446-2018-14-2-156-166.

32. Semenova А.Е., Sergienko I. V . Rosuvastatin the most potent statin in cardiovascular disease prevention. Eurasian heart journal. 2018; 2:28–34. (In Russ.).

33. Hirsch M., O’Donnell J.C., Jones P. Rosuvastatin is cost-effective in treating patients to lowdensity lipoprotein-cholesterol goals compared with atorvastatin, pravastatin and simvastatin: analysis of the STELLAR trial. Eur J Cardiovasc Prev Rehabil. 2005; 12:18–28.

34. Mach F., Koskinas K. C., Roeters van Lennep J. E. et al. 2025 Focused Update of the 2019 ESC/EAS Guidelines for the management of dyslipidaemias. Atherosclerosis. 2025; 0(0):120479.