Objective: To evaluate perioperative statin treatment, to explore the rapidly increasing body of literature on the pleiotropic effects of statins, and to suggest a rational strategy of perioperative risk reduction.
Summary of Background Data: Vascular, cerebrovascular, and cardiovascular complications are all too common in surgery. Although treatment with β-blockers is a well-established strategy for perioperative cardiac risk reduction, prophylaxis with statins enjoys a firm pathophysiologic basis.
Methods: A PubMed search for studies evaluating outcomes of statin treatment in surgical series was accomplished by evaluating all articles found with the keyword “surgery” and the MeSH term for statins “hydroxymethylglutaryl-CoA reductase inhibitors.” Studies where no outcome was relatable to statin treatment were excluded as were studies dealing primarily with transplant surgery. An overview of the medical literature on statin use and cardiac outcome was also performed. Basic science investigations elucidating the mechanisms and effects of statins that may reduce perioperative risk were included.
Results: The pharmacology and pleiotropic effects of statins are delineated. Multiple beneficial outcomes are elucidated and explored. Statins prescribed in the perioperative period appear beneficial though only one clinical trial is available from which to make clinical recommendations.
Conclusion: Evidence supports a rebound effect. Statin treatment should be instituted and must not be discontinued in surgical patients. Current literature suggests that statins are protective in the preoperative period.
This review delineates the pathophysiology of statin treatment on vasomotor tone, coagulation, and inflammation. The clinical evidence of statin therapy on perioperative outcomes is reviewed in detail and an overview of the effects of statins in the medical literature is given. Finally, the complications of statin use are investigated.
From the Department of Surgery, University of California, San Francisco-East Bay, Oakland, California.
Reprints: Trevor Williams, MD, MPH, Department of Surgery, Alameda County Medical Center, 1411 East 31st Street, Oakland, CA 94602. E-mail: firstname.lastname@example.org.