title: Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery: a review.
abstract: Statins feature documented benefits for primary and secondary prevention of cardiovascular disease and are thought to improve perioperative outcomes in patients undergoing surgery. To assess the clinical outcomes of perioperative statin treatment in statin-naive patients undergoing surgery, a systematic review was performed. Studies were included if they met the following criteria: randomized controlled trials, patients aged ≥18 yr undergoing surgery, patients not already on long-term statin treatment, reported outcomes including at least one of the following: mortality, myocardial infarction, atrial fibrillation, stroke, and length of hospital stay. The following randomized clinical trials were excluded: retrospective studies, trials without surgical procedure, trials without an outcome of interest, studies with patients on statin therapy before operation, or papers not written in English. The literature search revealed 16 randomized controlled studies involving 2275 patients. Pooled results showed a significant reduction in (i) mortality [risk ratio (RR) 0.53, 95% confidence interval (CI) 0.30-0.94, P=0.03], (ii) myocardial infarction (RR 0.54, 95% CI 0.38-0.76, P<0.001), (iii) perioperative atrial fibrillation (RR 0.53, 95% CI 0.43-0.66, P<0.001), and (iv) length of hospital stay (days, mean difference -0.58, 95% CI -0.79 to -0.37, P<0.001) in patients treated with a statin. Subgroup analysis in patients undergoing non-cardiac surgery showed a decrease in the perioperative incidence of mortality and myocardial infarction. Consequently, anaesthetists should consider prescribing a standard-dose statin before operation to statin-naive patients undergoing cardiac surgery. However, there are insufficient data to support final recommendations on perioperative statin therapy for patients undergoing non-cardiac surgery.
authors.affiliation: Department of Anesthesiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands britta.de.waal@mumc.nl.
authors.forename: B A
authors.initials: BA
authors.lastname: de Waal
authors.affiliation: Department of Anesthesiology, Catharina Hospital, Postbus 1350, 5602 ZA Eindhoven, The Netherlands.
authors.forename: M P
authors.initials: MP
authors.lastname: Buise
authors.affiliation: Discipline of Anesthesiology, The University of Queensland, Faculty of Medicine and Biomedical Sciences, Royal Brisbane and Women's Hospital, Herston Campus, Brisbane,QLD 4029, Australia.
authors.forename: A A J
authors.initials: AA
authors.lastname: van Zundert
mesh_terms: D001281:Atrial Fibrillation / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002318:Cardiovascular Diseases / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007902:Length of Stay / Q000706:statistics & numerical data; D009203:Myocardial Infarction / Q000517:prevention & control; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012306:Risk; D020521:Stroke / Q000517:prevention & control
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: patient outcome; perioperative period; statins