A peri-operative statin update for non-cardiac surgery. Part I: The effects of statin therapy on atherosclerotic disease and lessons learnt from statin therapy in medical (non-surgical) patients.

Abstract

The utility of peri-operative statin therapy is currently considered to be inconclusive. To provide a platform for more meaningful peri-operative statin literature in the future, this is the first of two review articles evaluating peri-operative statin therapy. This review examines the predictors of cardiovascular outcome and therapeutic targets which are established in medical (non-surgical) patients. In patients with stable coronary artery disease at least 4-6 weeks of standard statin therapy are required to realise most of the beneficial cellular and metabolic effects of statin therapy. Low-density lipoprotein-cholesterol reduction is associated with improved survival in these patients. In comparison, patients who sustain an acute coronary event require high-dose statin therapy probably initiated within 24 h with a therapeutic target of C-reactive protein reduction. Withdrawal of statin therapy results in a rapid return to endothelial dysfunction and amplification of the inflammatory process, which may increase cardiovascular risk.