title: Review article: The role of statins in reducing perioperative cardiac risk: Physiologic and clinical perspectives.
abstract: OBJECTIVE
  To review the pathobiology and clinical implications of coronary vulnerable atherosclerotic plaques (VAPs), to discuss the role of statin therapy in VAP stabilization, and the potential benefits of perioperative statin therapy (PST) in reducing perioperative risk of acute coronary syndromes (ACSs).
  
  
  METHODS
  MEDLINE search using "perioperative", "cardiac morbidity", "atherosclerosis", "vulnerable plaque", "statins" and combinations of these terms as keywords. The reference lists of relevant articles were further reviewed to identify additional citations.
  
  
  RESULTS
  The nonstenotic, yet rupture-prone VAP causes most myocardial infarctions (MIs) and other ACSs, both in the nonsurgical and surgical patients. Large clinical trials in both primary and secondary prevention and in patients with ACSs have demonstrated that statin therapy will reduce cardiovascular morbidity and mortality across a broad spectrum of patient subgroups. These trials also suggest, and laboratory investigations establish, that statins possess favourable vascular effects independent of cholesterol reduction. Statins appear to interfere specifically with the pathophysiologic mechanisms implicated in atherothrombotic disease. Statins reduce vascular inflammation, improve endothelial function, stabilize VAPs, and reduce platelet aggregability and thrombus formation. Recent studies have shown that PST is associated with a reduced incidence of perioperative and long-term cardiovascular complications in high-risk patients. Combined therapy with statins and ss-blockers is a conceptually valid strategy targeting critical steps in the pathogenesis of an ACS.
  
  
  CONCLUSIONS
  Emerging evidence for the efficacy and safety of PST is promising, especially when combined with ss-blocker therapy in patients at highest risk. Confirmation of this early evidence awaits the results of ongoing and future prospective randomized controlled trials.
authors.affiliation: Department of Anesthesia, Lower Bucks Hospital, 501 Bath Road, Bristol, PA 19007, USA. nadboush@hotmail.com
authors.forename: Nader N
authors.initials: NN
authors.lastname: Boushra
authors.forename: Muhammad
authors.initials: M
authors.lastname: Muntazar
mesh_terms: D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D050197:Atherosclerosis / Q000503:physiopathology; D000075202:Contraindications; D003327:Coronary Disease / Q000503:physiopathology; D006331:Heart Diseases / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012306:Risk
chemical_list: D000924:Anticholesteremic Agents