Study of Atorvastatin Versus Placebo to Reduce Cardiopulmonary Complications After Thoracic Surgery

Not Applicable

Completed

Brief Summary: This study will compare atorvastatin (Lipitor) with a placebo (inactive pill) to see if this drug reduces heart rhythm abnormalities (arrhythmias) or lung inflammation after thoracic surgery. Preliminary results suggest that cholesterol lowering drugs (statins) may reduce problems after surgery such as arrhythmias or lung inflammation which may be serious. This study will be randomized and double blind, meaning that patients are placed in groups purely by chance, like flipping a coin. Neither the patient or doctor will know which group the patient is in.

Detailed Description: Hypothesis: Statins attenuate perioperative inflammatory and oxidative mechanisms that contribute to the initiation and severity of cardiopulmonary complications after thoracic surgery.

Aim 1. To determine whether prophylactic administration of atorvastatin attenuates the inflammatory and oxidative response to surgery and significantly reduces the composite risk of cardiovascular morbidity (atrial fibrillation (AF), acute coronary syndrome, myocardial infarction (MI), cerebrovascular accident (CVA), pulmonary embolism) and mortality within 30 days after thoracic surgery.

Aim 2. To explore whether prophylactic administration of atorvastatin attenuates the inflammatory and oxidative (CRP, IL-6, TNF, and MPO) response to surgery and significantly reduces the overall risk of pulmonary complications (atelectasis, pneumonia, pneumonitis, acute respiratory failure) after thoracic surgery.

Aim 3. To explore the association of single nucleotide polymorphism (SNP) changes in genes linked to atrial fibrillation and inflammatory markers and development of pulmonary morbidity after thoracic surgery.

Aim 4. To explore whether an imbalance between metalloproteinase (MMP)-1 and its inhibitor (TIMP) is associated with postoperative atrial fibrillation risk and/or development of pulmonary morbidity after thoracic surgery.

Recruitment & Eligibility

Inclusion Criteria

Adult patients ≥ 18 yr. scheduled for anatomic lung resection (segmentectomy, lingulectomy, possible or definite lobectomy, bilobectomy, pneumonectomy or extrapleural pneumonectomy) with or without chest wall resection or limited resection
Patients with regular cardiac rhythm
Patients able to take oral capsules
Patients capable of providing written, informed consent
Patients without known hepatic or kidney disease

Exclusion Criteria

Patients already taking any statin, gemfibrozil (Lopid), or ezetimibe (Zetia)
Hypersensitivity to atorvastatin
Chronic atrial fibrillation
Patients already taking class Ic or III antiarrhythmic drugs
Known pregnancy a urine pregnancy test will be given to women of childbearing age
Known history of active hepatic disease or known hepatic insufficiency
Known history of active kidney disease or insufficiency

Arm && Interventions

Group	Intervention	Description
1	Atorvastatin	Atorvastatin
2	Placebo	placebo

Primary Outcome Measures

Name	Time	Method
Determine the Postoperative Complications Found in Each Group	one week (minimum of 5 days) before surgery and continued for one week (minimum of 5 days) after surgery	To determine whether one week of preventive therapy with atorvastatin prior to surgery and one week after surgery reduced the composite rate of cardiovascular morbidity when compared to placebo.

Secondary Outcome Measures