Statins for all: the new premed?

• Published in: British journal of anaesthesia : BJA Vol. 103; no. 1; pp. 99 - 107
• Main Authors: Brookes, Z.L.S., McGown, C.C., Reilly, C.S.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-07-2009; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Atherosclerosis - drug therapy; Biological and medical sciences; complications; complications, sepsis; Endothelium, Vascular - drug effects; Endothelium, Vascular - physiopathology; heart; heart, ischaemia; Humans; hydroxymethylglutaryl-CoA; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - pharmacology; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; inhibitors; inhibitors, reductase, hydroxymethylglutaryl-CoA; ischaemia; Medical sciences; Mice; nitric oxide; nitric oxide synthase; Perioperative Care - methods; pharmacology; pharmacology, statins; Premedication - methods; reductase; sepsis; Sepsis - prevention & control; statins; complications, sepsis; pharmacology, statins; heart, ischaemia; nitric oxide; nitric oxide synthase; inhibitors, reductase, hydroxymethylglutaryl-CoA; inhibitors; complications; Enzyme; Cardiovascular disease; Statin derivative; Nitric-oxide synthase; heart; Infection; Sepsis syndrome; ischaemia; Ischemia; Nitric oxide; statins; pharmacology; Anesthesia; Complication; hydroxymethylglutaryl-CoA; Oxidoreductases; sepsis; Antilipemic agent; Reductase
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aep149

The use of statins is widespread and many patients presenting for surgery are regularly taking them. There is evidence that statins have beneficial effects beyond those of lipid lowering, including reducing the perioperative risk of cardiac complications and sepsis. This review addresses the cellular mechanisms by which statins may produce these effects. Statins appear to have actions on vascular nitric oxide through the balance of inducible and endothelial nitric oxide synthase. The clinical evidence for these benefits is also briefly reviewed with the objective of clarifying the current status of statin use in the perioperative period. There is reasonably strong evidence that patients already taking statins should continue on them perioperatively. However, the evidence for the prophylactic use of statins perioperatively is weak and lacks prospective controlled studies.