title: Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies.
abstract: OBJECTIVE
  To determine the strength of evidence underlying recommendations for use of statins during the perioperative period to reduce the risk of cardiovascular events.
  
  
  METHODS
  Systematic review of studies with concurrent control groups.
  
  
  METHODS
  Four electronic databases, the references of identified studies, international experts on perioperative medicine, and the authors of the primary studies. Review methods Two reviewers independently extracted data from studies that reported acute coronary syndromes or mortality in patients receiving or not receiving statins during the perioperative period.
  
  
  METHODS
  Random effects summary odds ratios for death or acute coronary syndrome during the perioperative period.
  
  
  RESULTS
  18 studies--two randomised trials (n=177), 15 cohort studies (n=799,632), and one case-control study (n=480)--assessed whether statins provide perioperative cardiovascular protection; 12 studies enrolled patients undergoing non-cardiac vascular surgery, four enrolled patients undergoing coronary bypass surgery, and two enrolled patients undergoing various surgical procedures. In the randomised trials the summary odds ratio for death or acute coronary syndrome during the perioperative period with statin use was 0.26 (95% confidence interval 0.07 to 0.99) and the summary odds ratio in the cohort studies was 0.70 (0.57 to 0.87). Although the pooled cohort data provided a statistically significant result, statins were not randomly allocated, results in retrospective studies were larger (odds ratio 0.65, 0.50 to 0.84) than those in the prospective cohorts (0.91, 0.65 to 1.27), and dose, duration, and safety of statin use was not reported.
  
  
  CONCLUSIONS
  The evidence base for routine administration of statins to reduce perioperative cardiovascular risk is inadequate.
authors.affiliation: Division of General Internal Medicine, University of Alberta, 8440 112 Street, Edmonton, AB, Canada T6G 2R7.
authors.forename: Anmol S
authors.initials: AS
authors.lastname: Kapoor
authors.forename: Hussein
authors.initials: H
authors.lastname: Kanji
authors.forename: Jeanette
authors.initials: J
authors.lastname: Buckingham
authors.forename: P J
authors.initials: PJ
authors.lastname: Devereaux
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
mesh_terms: D016022:Case-Control Studies; D003327:Coronary Disease / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007431:Intraoperative Complications / Q000517:prevention & control; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors