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Statin loading in cardiovascular surgery: never too early to treat

Katsiki, Nikia; Triposkiadis, Filipposb; Giannoukas, Athanasios, D.c; Mikhailidis, Dimitri, P.d

Current Opinion in Cardiology: July 2018 - Volume 33 - Issue 4 - p 436–443
doi: 10.1097/HCO.0000000000000519
LIPIDS AND EMERGING RISK FACTORS: Edited by Dimitri P. Mikhailidis and Anthony S. Wierzbicki

Purpose of review The effects of statin loading before, during or after vascular interventions on cardiovascular and renal outcomes are discussed. Furthermore, the selection of optimal statin type and dose, according to current evidence or guidelines, is considered. The importance of treating statin intolerance and avoiding statin discontinuation is also discussed.

Recent findings Statin loading has been shown to beneficially affect cardiovascular outcomes, total mortality and/or contrast-induced acute kidney injury, in patients undergoing vascular procedures such as percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), carotid artery stenting, endovascular aneurysm repair, open abdominal aortic aneurysms (AAA) repair and lower extremities vascular interventions. High-dose statin pretreatment is recommended for PCI and CABG according to current guidelines. Statin discontinuation should be avoided during acute cardiovascular events and vascular interventions; adequate measures should be implemented to overcome statin intolerance.

Summary Statin loading is an important clinical issue in patients with cardiac and noncardiac vascular diseases, including carotid artery disease, peripheral artery disease and AAA, undergoing vascular interventions. Cardiologists and vascular surgeons should be aware of current evidence and implement guidelines in relation to statin loading, discontinuation and intolerance.

aSecond Propedeutic Department of Internal Medicine, Medical School, Aristotle, University of Thessaloniki, Hippocration Hospital, Thessaloniki

bDepartment of Cardiology, Larissa University Hospital, Larissa

cDepartment of Vascular Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece

dDepartment of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK

Correspondence to Dimitri P. Mikhailidis, MD, FRCP, FRCPath, Department of Clinical Biochemistry, Royal Free Hospital campus, University College London Medical School, University College London (UCL), Pond Street, London NW3 2QG, UK. Tel: +44 20 7830 2258; fax: +44 20 7830 2235; e-mail:

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