title: Statin intake is associated with decreased insulin sensitivity during cardiac surgery.
abstract: OBJECTIVE
  Surgical trauma impairs intraoperative insulin sensitivity and is associated with postoperative adverse events. Recently, preprocedural statin therapy is recommended for patients with coronary artery disease. However, statin therapy is reported to increase insulin resistance and the risk of new-onset diabetes. Thus, we investigated the association between preoperative statin therapy and intraoperative insulin sensitivity in nondiabetic, dyslipidemic patients undergoing coronary artery bypass grafting.
  
  
  METHODS
  In this prospective, nonrandomized trial, patients taking lipophilic statins were assigned to the statin group and hypercholesterolemic patients not receiving any statins were allocated to the control group. Insulin sensitivity was assessed by the hyperinsulinemic-normoglycemic clamp technique during surgery. The mean, SD of blood glucose, and the coefficient of variation (CV) after surgery were calculated for each patient. The association between statin use and intraoperative insulin sensitivity was tested by multiple regression analysis.
  
  
  RESULTS
  We studied 120 patients. In both groups, insulin sensitivity gradually decreased during surgery with values being on average ∼20% lower in the statin than in the control group. In the statin group, the mean blood glucose in the intensive care unit was higher than in the control group (153 ± 20 vs. 140 ± 20 mg/dL; P < 0.001). The oscillation of blood glucose was larger in the statin group (SD, P < 0.001; CV, P = 0.001). Multiple regression analysis showed that statin use was independently associated with intraoperative insulin sensitivity (β = -0.16; P = 0.03).
  
  
  CONCLUSIONS
  Preoperative use of lipophilic statins is associated with increased insulin resistance during cardiac surgery in nondiabetic, dyslipidemic patients.
authors: Department of Anaesthesia, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada. hsatou@yamanashi.ac.jp
authors: Hiroaki
authors: H
authors: Sato
authors: George
authors: G
authors: Carvalho
authors: Tamaki
authors: T
authors: Sato
authors: Roupen
authors: R
authors: Hatzakorzian
authors: Ralph
authors: R
authors: Lattermann
authors: Takumi
authors: T
authors: Codere-Maruyama
authors: Takashi
authors: T
authors: Matsukawa
authors: Thomas
authors: T
authors: Schricker
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D015309:Glucose Clamp Technique; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D006937:Hypercholesterolemia / Q000601:surgery; D007333:Insulin Resistance / Q000502:physiology*; D016343:Monitoring, Intraoperative; D011300:Preoperative Care
chemical_list: D001786:Blood Glucose; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors