| Article Access Statistics|
| Viewed||1007 |
| Printed||15 |
| Emailed||0 |
| PDF Downloaded||117 |
| Comments ||[Add] |
Click on image for details.
|Year : 2017
: 20 | Issue : 5 | Page
|Pleiotropic effects of statins in the perioperative setting
George Galyfos1, Argyri Sianou2, Konstantinos Filis1
1 Department of Propaedeutic Surgery, Division of Vascular Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
2 Department of Microbiology, University of Athens Medical School, Areteion Hospital, Athens, Greece
Click here for correspondence address and
|Date of Web Publication||6-Jan-2017|
| Abstract|| |
Statins belong to a specific group of drugs that have been described for their ability to control hyperlipidemia as well as for other pleiotropic effects such as improving vascular endothelial function, inhibition of oxidative stress pathways, and anti-inflammatory actions. Accumulating clinical evidence strongly suggests that statins also have a beneficial effect on perioperative morbidity and mortality. Therefore, this review aims to present all recent and pooled data on statin treatment in the perioperative setting as well as to highlight considerations regarding their indications and therapeutic application.
Keywords: Cardiac surgery, noncardiac surgery, perioperative management, statins
|How to cite this article:|
Galyfos G, Sianou A, Filis K. Pleiotropic effects of statins in the perioperative setting. Ann Card Anaesth 2017;20, Suppl S1:43-8
|How to cite this URL:|
Galyfos G, Sianou A, Filis K. Pleiotropic effects of statins in the perioperative setting. Ann Card Anaesth [serial online] 2017 [cited 2019 Oct 23];20, Suppl S1:43-8. Available from: http://www.annals.in/text.asp?2017/20/5/43/197796
| Introduction|| |
Statins are inhibitors of 3-hydroxy-3- methylglutaryl-coenzyme A reductase, and they are used to inhibit cholesterol biosynthesis in the liver.  Hypercholesterolemia is a major risk factor for the development of cardiovascular diseases, coronary artery disease, and stroke, secondary to the prothrombotic and atherosclerotic effects. In general, administration of statins reduces serum concentrations of total cholesterol and low-density lipoprotein (LDL) by 17%-35% and 24%-49%, respectively. Furthermore, levels of triglycerides are reduced by 13%, and high-density lipoprotein (HDL) levels are increased by 5% following treatment with statins.  Finally, statins may have antithrombotic effects, unrelated to cholesterol reduction, as well as anti-inflammatory effects through the downregulation of cytokines. 
Regarding patients undergoing cardiac as well as noncardiac surgery, major adverse cardiac and cerebrovascular events (MACCEs), although infrequent, can be life threatening, representing the most common cause of serious perioperative morbidity and mortality, with reported incidence rates ranging between 1% and 7%.  Most MACCE-related deaths after major surgery arise from cardiovascular complications such as myocardial ischemia (MI) or infarction, arrhythmias, and stroke. Moreover, acute renal injury remains another major postoperative complication after cardiac or noncardiac surgery, with a reported incidence of over 10% in large series.  To reduce the risk for these postoperative adverse events, optimal perioperative medical treatment remains one of the cornerstones of proper perioperative management. Therefore, the aim of this review is to present available data on the effect and characteristics of statin treatment in the perioperative setting.
| Basic Actions of Statins|| |
Vascular oxidative stress is a key feature of atherogenesis, and statins seem to regulate basic molecular pathways such as NADPH oxidase and nitric oxide (NO) synthase activity.  Accordingly, statins regulate glutamate metabolism, angiogenesis, immunity, and endothelial progenitor cells (EPCs) functions.  The vasculoprotective effect of statins is mainly mediated by inhibition of the mevalonate pathway and oxidized LDL generation, thereby enhancing the biosynthesis of endothelium-derived NO.  They also induce vasorelaxation by restoring endothelial NO-dependent dysfunction and endothelial nitric oxide synthase protein content in arterial tissue. , They seem to improve neovascularization in ischemia mice as well, an effect probably mediated by increased expression of CXCR4, a stromal cell-derived factor-1, in EPCs.  Finally, in experimental models of MI and heart failure, statins normalized the sympathetic outflow and reflex regulation and attenuated left ventricular remodeling, whereas in humans with dilated cardiomyopathy, short-term use of statins is associated with the improvement of cardiac function and symptoms. 
Emerging evidence data suggest that statins have also a beneficial effect not only on the size as well as the morphology of the atherosclerotic plaques.  They seem to protect patients with stable coronary artery disease from presenting a recurrent coronary event  as well as patients with acute ischemic stroke from future cerebrovascular events and all-cause death.  The effect of statins has been evaluated and established not only in carotid as well as atherosclerotic plaques. Recent pooled data have shown that statin therapy is associated with a favorable increase of carotid plaque echogenicity, independently of changes in LDL and HDL levels.  Furthermore, statins seem to significantly reduce coronary plaque volume and external elastic membrane volume although dense calcium volumes are increased, stabilizing the plaques.  In addition, statin treatment shows a beneficial effect on renal function, increasing the glomerular filtration rate, and reducing proteinuria moderately.  Finally, recent data show that statins could also have protective effects against genomic damage or facilitate the potentiation of DNA repair capacity. 
| Types of Surgery|| |
In a large single-institution study evaluating almost 8000 surgery cases of different types, the preoperative use of statins was associated with lower rate of major adverse events, mainly respiratory complications, infections, and deep vein thrombosis events.  In another large retrospective study, Raju et al. evaluated a population undergoing abdominal, orthopedic, and urological procedures.  Statin therapy decreased the composite end point consisting of 30-day all-cause mortality, atrial fibrillation, and nonfatal MI. After further adjustment of other risk factors such as diabetes mellitus or prior cardiac intervention, statin treatment proved to be beneficial also.  Finally, in a large systematic review, statins significantly reduced the risk for postprocedural MI in all types of surgery.  Likewise, de Waal et al. evaluated 16 studies of patients undergoing different types of surgery. Pooled results indicated a significant reduction in mortality, MI, atrial fibrillation as well as hospital stay length. 
Furthermore, statins seem to have little or no beneficial effects on mortality or cardiovascular events and uncertain adverse effects, in adults treated with dialysis, despite clinically relevant reductions in serum cholesterol levels.  As aforementioned, the beneficial effects of statins on renal function itself seem to be moderate.  Even in patients receiving kidney transplants, pooled data have shown that statins may reduce cardiovascular events in such procedures although treatment effects are imprecise. Statin treatment has uncertain effects on overall mortality, stroke, kidney function, and toxicity outcomes in kidney transplant recipients. Therefore, more data are needed for this specific group of patients. 
The first prospective randomized study reported in 1999 demonstrated that a 4-week treatment with simvastatin (20 mg/day) significantly improved the events of postoperative thrombocytosis, MI, and renal insufficiency in hypercholesterolemic patients after coronary artery bypass grafting (CABG).  However, in a more recent randomized trial of patients undergoing cardiac surgery, high-dose atorvastatin did not reduce acute kidney injury risk compared to placebo, and therefore, these results do not support the initiation of statins to protect kidneys after cardiac surgery.  Even in patients undergoing isolated cardiac valve surgery, statin therapy decreases early mortality,  according to some authors. However, recent pooled data indicate that there is presently insufficient evidence to recommend routine statin therapy in patients undergoing isolated valve surgery, unless concomitant hypercholesterolemia or coronary artery disease is present. 
In a recent meta-analysis by Lewicki et al., there was no association of preoperative statin use with a decreased incidence of acute kidney injury after surgery requiring cardiac bypass.  Although a significant reduction in serum creatinine was observed in patients treated with statins, this result was driven mainly from one randomized trial. Therefore, more randomized data are needed to produce safer results. Likewise, Kuhn et al. have identified 17 randomized controlled trials including a total of 2138 participants.  They found that preoperative statin therapy reduces the odds of postoperative atrial fibrillation and shortens the patient's stay on the Intensive Care Unit (ICU) as well as in the hospital. Statin pretreatment had no influence on perioperative mortality, stroke, MI, or renal failure, but only two of all included studies assessed mortality. However, as the evaluated studies included mainly individuals undergoing myocardial revascularization, results cannot be extrapolated to patients undergoing other cardiac procedures such as heart valve or aortic surgery.
In 2003, Poldermans et al. published one of the first large-scale case-controlled studies (n = 2816) evaluating the role of statins in vascular surgery patients. They provided evidence demonstrating that statin therapy significantly reduced the mortality (8% vs. 25%) during the perioperative phase in this group of patients (adjusted odds ratio [OR] = 0.22 [95% confidence interval (CI) = 0.10-0.47]).  However, the most solid evidence of cardiovascular protective effect of statins in noncardiac vascular surgery came from the landmark randomized controlled trial reported by the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group in 2009. Incidence of postoperative MI was reduced in patients treated with fluvastatin in this study (10.8% vs. 19.0%; hazard ratio = 0.55; 95% CI = 0.34-0.88; P = 0.01).  Even in studies evaluating carotid stenting only, preinterventional statin medication has shown a protective effect against peri-interventional stroke, MI, or death.  Even in patients undergoing infrainguinal bypass only, statin use was associated with fewer combined perioperative cardiac and major vascular complications, a shorter length of stay, and improved long-term survival.  Hence, statin withdrawal more than 4 days after aortic surgery is associated with a three-fold higher risk of postoperative MI. 
In a meta-analysis including four randomized and twenty observational studies, Antoniou et al. have shown that statin therapy is beneficial in improving operative and interventional outcomes in vascular and endovascular surgery.  Statin therapy reduced the risk for all-cause mortality, MI, stroke, and composite MI/stroke/death. Therefore, the authors recommended statin therapy for optimization of prevention strategies against cardiovascular and cerebrovascular events and death in such patients. However, no significant benefit concerning cardiovascular mortality and kidney injury was observed.  In another systematic review by Sanders et al., only randomized trials were included (six eligible studies in total). Evidence from that study, however, was insufficient to allow authors to conclude whether statins result in either a reduction or an increase in any outcome. 
In conclusion, evidence to date indicates that perioperative statin treatment shows a beneficial effect against cardiovascular complications after cardiac, vascular, and noncardiovascular surgery although the effect against postoperative renal injury or respiratory failure has not been established clearly. Moreover, research data remain inconclusive for certain populations such as patients undergoing renal transplantation.
| Dosage and Regimens|| |
Unfortunately, there has not been a comparative randomized study evaluating different types of statin regimens, regarding their effect on postoperative outcomes. However, there have been studies evaluating specific statin types in surgical patients. Rosuvastatin is a more potent lipid-lowering agent compared to atorvastatin, pravastatin, simvastatin, lovastatin, or fluvastatin.  Compared to other statins, rosuvastatin shows a similarly low risk for significant muscle damage (myopathy and rhabdomyolysis) and no consistent pattern of renal failure or renal injury, despite a mild transient tubular proteinuria, as seen with all statins.
Xia et al. have found that preoperative rosuvastatin reload therapy decreases the incidence of MI and major cardiovascular/cerebrovascular events in patients with stable coronary disease undergoing noncardiac surgery.  Recently, the ROMA II trial has concluded that procedural and long-term outcomes in patients undergoing percutaneous coronary intervention (PCI) are improved by high-dose statin reloading although no difference was observed between rosuvastatin and atorvastatin.  From the currently available information, no specific single type of statin seems to be preferable over the others. One should, however, consider prescribing statins with a prolonged half-life time or with a slow-release formula in patients who would not be able to take per os medication, such as patients undergoing major vascular surgery or abdominal surgery. 
In another published review, the authors conclude that in the absence of adverse effects, rosuvastatin or atorvastatin ≥20 mg/day is the optimal statin type and dosage for vascular patients.  However, in the PCI studies, 56% of the weight of the pooled data come from trials of atorvastatin ≥40 mg, 58% of the CABG studies involve atorvastatin ≥20 mg, and 91% of the noncardiac surgery trials involve fluvastatin 80 mg.  Meta-regression analysis has not found any difference among different types of statins concerning the relative risk for postprocedural MI.  In another meta-analysis by Liakopoulos et al., only studies referring to cardiac surgery were included.  Most of these studies evaluated atorvastatin, concurring with the analysis by Winchester et al.  Atorvastatin was found to reduce the risk for atrial fibrillation and length of stay in hospital after cardiac surgery although the effect on stroke, MI, renal failure, and ICU stay was not significant. 
The timing of initiation of statin therapy with respect to noncardiac surgery is yet to be defined as there is no clear guideline on when the drugs should be started. Four weeks should allow time for a maximal clinical effect and identification of efficacy (lipid lowering) or side effects (rhabdomyolysis or raised liver enzymes) according to many authors.  Statins should be taken on the day of (or the evening before) surgery to maximize the potential benefit. It is also crucial that statin treatment is resumed as soon as possible after surgery. A study comparing cardiovascular outcomes in patients resuming statin therapy 1 day after vascular surgery with patients resuming treatment a median of 4 days after vascular surgery showed that earlier statin initiation was associated with a 5.5-fold reduced risk for postoperative MI or elevated troponin levels (OR, 0.38 vs. 2.1; P < 0.001). 
In conclusion, data remain insufficient to recommend a certain type or dosage of statin for perioperative management. However, it is important not to discontinue statin therapy before surgery.
| Adverse Effects and Interactions|| |
The statin-induced adverse effects may be dose-related. Data comparing intensive- and moderate-dose statin therapy for the reduction of cardiovascular events have shown that intensive therapy with atorvastatin or simvastatin 80 mg is associated with a significant increase in the risk for any adverse event as well as adverse events requiring discontinuation of therapy. Intensive therapy is also associated with abnormal liver function tests and elevated creatine kinase activity. However, there is no evidence that statins aggravate existing hepatic disease.  Atorvastatin is associated with the greatest and fluvastatin with the lowest risk for adverse events. However, simvastatin, pravastatin, and lovastatin have intermediate risks for causing adverse events.  The relatively rare and usually mild statin-induced adverse effects are thus counterbalanced by the benefits associated with high-dose treatment. The most common adverse events related to statin therapy are myopathy/rhabdomyolysis and elevated liver enzymes, with incidences of 0.04%-0.07% and 1.18%, respectively. Patients with advanced age (>80 years), small body frame, coexisting chronic diseases (such as chronic renal failure and severe liver impairment), multiple medications, and chronic alcoholism are at an increased risk for the development of statin-related adverse effects. 
Regarding the interactions of statins with other agents, the cytochrome P450 (CYP) isoenzyme system is of particular interest. Most drugs are metabolized in the liver by the CYP 3A4 isoenzyme. This might cause interaction with statins, resulting in elevated plasma levels, and consequently an increased risk for adverse events. Lovastatin, simvastatin, and atorvastatin are also metabolized through this pathway. Fluvastatin and rosuvastatin, however, have only limited interactions with the CYP 3A4 pathway. Fluvastatin is mainly metabolized by the CYP 2C9 isoenzyme, and rosuvastatin is not extensively metabolized and has only minor interaction with the 2C9 isoenzyme. In the nonoperative setting, most statin-induced rhabdomyolysis cases have been associated with the use of mibefradil, fibrates, cyclosporine, macrolide antibiotics, warfarin, digoxin, or azole antifungals.  Nevertheless, coadministration with Vitamin K antagonists, cyclosporine, gemfibrozil, and antiretroviral agents should be carried out with caution since a potential pharmacokinetic interaction with these drugs may increase the risk of toxicity. 
In conclusion, adverse effects of statins are infrequent and usually mild, and therefore, the dosage should be determined mainly based on the beneficial cardiovascular effects in each case. Attention should be paid when certain agents are coadministered to reduce the toxicity risk.
| Recommendations|| |
Both the American College of Cardiology/American Heart Association as well as the European Society of Cardiology (ESC) strongly recommend that patients who are currently under statin therapy should continue taking statins during the perioperative period of noncardiac and vascular surgery. , [Table 1] includes both American and European recommendations regarding perioperative statin treatment in noncardiac surgery. Regarding the preoperative initiation of statins, data are less robust, and therefore, the recommendations are weaker. However, at least for vascular surgery or higher risk surgery in general, the initiation is recommended, ideally 2 weeks before surgery according to the ESC (Recommendation: IIa; B).
|Table 1: American and European recommendations regarding statin therapy in patients undergoing noncardiac surgery |
Click here to view
Regarding CABG surgery, the latest American recommendations are included in [Table 2].  As with other noncardiac procedures, the guidelines strictly recommend against the discontinuation of statin treatment before CABG surgery. However, the recommendations are more detailed regarding the dose of statin and target levels of LDL. The benefits of post-CABG LDL lowering with statins have been reported previously, but no prospective studies of the impact of preoperative LDL cholesterol lowering on post-CABG outcomes are available. Postoperatively, statin use should be resumed when the patient is able to take oral medications and should be continued indefinitely.  Regarding valve surgery, there is no specific recommendation regarding statin treatment. However, coronary artery disease is usually present in cases with calcific aortic valve stenosis scheduled for combined repair, so the aforementioned recommendations for CABG would apply for this subgroup as well.
|Table 2: American recommendations regarding statin therapy in patients undergoing coronary artery bypass grafting surgery |
Click here to view
| Conclusions|| |
Although there are significant pooled data supporting the beneficial effect of statins on cardiovascular morbidity and mortality in patients undergoing either cardiac or noncardiac surgery, randomized data comparing the different statin types and dosages are still lacking. Moreover, although the protective effect against perioperative cardiovascular or cerebrovascular events is more clearly established, data on a potential pleiotropic effect against other major complications such as renal injury or respiratory failure are still inconclusive. However, according to the most recent guidelines, statins should be initiated as early as possible before surgery, especially in patients of higher risk such as vascular or coronary disease patients, and they should not be discontinued prior or after surgery.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Iannuzzi JC, Rickles AS, Kelly KN, Rusheen AE, Dolan JG, Noyes K, et al.
Perioperative pleiotropic statin effects in general surgery. Surgery 2014;155:398-407.
Edwards JE, Moore RA. Statins in hypercholesterolaemia: A dose-specific meta-analysis of lipid changes in randomised, double blind trials. BMC Fam Pract 2003;4:18.
Undas A, Brozek J, Musial J. Anti-inflammatory and antithrombotic effects of statins in the management of coronary artery disease. Clin Lab 2002;48:287-96.
Davenport DL, Ferraris VA, Hosokawa P, Henderson WG, Khuri SF, Mentzer RM Jr. Multivariable predictors of postoperative cardiac adverse events after general and vascular surgery: Results from the patient safety in surgery study. J Am Coll Surg 2007;204:1199-210.
Grams ME, Sang Y, Coresh J, Ballew S, Matsushita K, Molnar MZ, et al.
Acute kidney injury after major surgery: A retrospective analysis of veterans health administration data. Am J Kidney Dis 2016;67:872-80.
Antonopoulos AS, Margaritis M, Shirodaria C, Antoniades C. Translating the effects of statins: From redox regulation to suppression of vascular wall inflammation. Thromb Haemost 2012;108:840-8.
Blum A. HMG-CoA reductase inhibitors (statins), inflammation, and endothelial progenitor cells-new mechanistic insights of atherosclerosis. Biofactors 2014;40:295-302.
Fang SY, Roan JN, Luo CY, Tsai YC, Lam CF. Pleiotropic vascular protective effects of statins in perioperative medicine. Acta Anaesthesiol Taiwan 2013;51:120-6.
Miyata R, Hiraiwa K, Cheng JC, Bai N, Vincent R, Francis GA, et al.
Statins attenuate the development of atherosclerosis and endothelial dysfunction induced by exposure to urban particulate matter (PM10). Toxicol Appl Pharmacol 2013;272:1-11.
Bates K, Ruggeroli CE, Goldman S, Gaballa MA. Simvastatin restores endothelial NO-mediated vasorelaxation in large arteries after myocardial infarction. Am J Physiol Heart Circ Physiol 2002;283:H768-75.
Chiang KH, Cheng WL, Shih CM, Lin YW, Tsao NW, Kao YT, et al.
Statins, HMG-CoA reductase inhibitors, improve neovascularization by increasing the expression density of CXCR4 in endothelial progenitor cells. PLoS One 2015;10:e0136405.
Node K, Fujita M, Kitakaze M, Hori M, Liao JK. Short-term statin therapy improves cardiac function and symptoms in patients with idiopathic dilated cardiomyopathy. Circulation 2003;108:839-43.
Artom N, Montecucco F, Dallegri F, Pende A. Carotid atherosclerotic plaque stenosis: The stabilizing role of statins. Eur J Clin Invest 2014;44:1122-34.
Chan YC, Cheng SW, Irwin MG. Perioperative use of statins in noncardiac surgery. Vasc Health Risk Manag 2008;4:75-81.
Makihara N, Kamouchi M, Hata J, Matsuo R, Ago T, Kuroda J, et al.
Statins and the risks of stroke recurrence and death after ischemic stroke: The Fukuoka Stroke Registry. Atherosclerosis 2013;231:211-5.
Ibrahimi P, Jashari F, Bajraktari G, Wester P, Henein MY. Ultrasound assessment of carotid plaque echogenicity response to statin therapy: A systematic review and meta-analysis. Int J Mol Sci 2015;16:10734-47.
Banach M, Serban C, Sahebkar A, Mikhailidis DP, Ursoniu S, Ray KK, et al.
Impact of statin therapy on coronary plaque composition: A systematic review and meta-analysis of virtual histology intravascular ultrasound studies. BMC Med 2015;13:229.
Geng Q, Ren J, Song J, Li S, Chen H. Meta-analysis of the effect of statins on renal function. Am J Cardiol 2014;114:562-70.
Pernice F, Floccari F, Caccamo C, Belghity N, Mantuano S, Pacilè ME, et al.
Chromosomal damage and atherosclerosis. A protective effect from simvastatin. Eur J Pharmacol 2006;532:223-9.
Raju MG, Pachika A, Punnam SR, Gardiner JC, Shishehbor MH, Kapadia SR, et al.
Statin therapy in the reduction of cardiovascular events in patients undergoing intermediate-risk noncardiac, nonvascular surgery. Clin Cardiol 2013;36:456-61.
Winchester DE, Wen X, Xie L, Bavry AA. Evidence of pre-procedural statin therapy a meta-analysis of randomized trials. J Am Coll Cardiol 2010;56:1099-109.
de Waal BA, Buise MP, van Zundert AA. Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery: A review. Br J Anaesth 2015;114:44-52.
Palmer SC, Navaneethan SD, Craig JC, Johnson DW, Perkovic V, Nigwekar SU, et al.
HMG CoA reductase inhibitors (statins) for dialysis patients. Cochrane Database Syst Rev 2013;11(9):CD004289.
Palmer SC, Navaneethan SD, Craig JC, Perkovic V, Johnson DW, Nigwekar SU, et al.
HMG CoA reductase inhibitors (statins) for kidney transplant recipients. Cochrane Database Syst Rev 2014;28(1):CD005019.
Christenson JT. Preoperative lipid-control with simvastatin reduces the risk of postoperative thrombocytosis and thrombotic complications following CABG. Eur J Cardiothorac Surg 1999;15:394-9.
Billings FT 4 th
, Hendricks PA, Schildcrout JS, Shi Y, Petracek MR, Byrne JG, et al.
High-dose perioperative atorvastatin and acute kidney injury following cardiac surgery: A randomized clinical trial. JAMA 2016;315:877-88.
Cheng X, Hu Q, Liu Z, Tang X. Preoperative statin therapy decreases early mortality in patients undergoing isolated valve surgery: Result from a meta-analysis. J Cardiothorac Vasc Anesth 2015;29:107-14.
Chacko J, Harling L, Ashrafian H, Athanasiou T. Can statins improve outcomes after isolated cardiac valve surgery? A systematic literature review. Clin Cardiol 2013;36:448-55.
Lewicki M, Ng I, Schneider AG. HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass. Cochrane Database Syst Rev 2015;11(3):CD010480.
Kuhn EW, Slottosch I, Wahlers T, Liakopoulos OJ. Preoperative statin therapy for patients undergoing cardiac surgery. Cochrane Database Syst Rev 2012;18(4):CD008493.
Poldermans D, Bax JJ, Kertai MD, Krenning B, Westerhout CM, Schinkel AF, et al.
Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation 2003;107:1848-51.
Schouten O, Boersma E, Hoeks SE, Benner R, van Urk H, van Sambeek MR, et al.
Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009;361:980-9.
Reiff T, Amiri H, Rohde S, Hacke W, Ringleb PA. Statins reduce peri-procedural complications in carotid stenting. Eur J Vasc Endovasc Surg 2014;48:626-32.
Ward RP, Leeper NJ, Kirkpatrick JN, Lang RM, Sorrentino MJ, Williams KA. The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular surgery. Int J Cardiol 2005;104:264-8.
Le Manach Y, Godet G, Coriat P, Martinon C, Bertrand M, Fléron MH, et al.
The impact of postoperative discontinuation or continuation of chronic statin therapy on cardiac outcome after major vascular surgery. Anesth Analg 2007;104:1326-33.
Antoniou GA, Hajibandeh S, Hajibandeh S, Vallabhaneni SR, Brennan JA, Torella F. Meta-analysis of the effects of statins on perioperative outcomes in vascular and endovascular surgery. J Vasc Surg 2015;61:519-32.e1.
Sanders RD, Nicholson A, Lewis SR, Smith AF, Alderson P. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery. Cochrane Database Syst Rev 2013;7:CD009971.
Paraskevas KI, Mikhailidis DP, Veith FJ. Optimal statin type and dosage for vascular patients. J Vasc Surg 2011;53:837-44.
Xia J, Qu Y, Yin C, Xu D. Preoperative rosuvastatin protects patients with coronary artery disease undergoing noncardiac surgery. Cardiology 2015;131:30-7.
Sardella G, Lucisano L, Mancone M, Conti G, Calcagno S, Stio RE, et al.
Comparison of high reloading ROsuvastatin and Atorvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of MyocArdial periprocedural necrosis. The ROMA II trial. Int J Cardiol 2013;168:3715-20.
Schouten O, Bax JJ, Dunkelgrun M, Feringa HH, van Urk H, Poldermans D. Statins for the prevention of perioperative cardiovascular complications in vascular surgery. J Vasc Surg 2006;44:419-24.
Liakopoulos OJ, Kuhn EW, Slottosch I, Wassmer G, Wahlers T. Preoperative statin therapy for patients undergoing cardiac surgery. Cochrane Database Syst Rev 2012;4:CD008493.
Silva MA, Swanson AC, Gandhi PJ, Tataronis GR. Statin-related adverse events: A meta-analysis. Clin Ther 2006;28:26-35.
Bellosta S, Paoletti R, Corsini A. Safety of statins: Focus on clinical pharmacokinetics and drug interactions. Circulation 2004;109 23 Suppl 1:III50-7.
Kostapanos MS, Milionis HJ, Elisaf MS. Rosuvastatin-associated adverse effects and drug-drug interactions in the clinical setting of dyslipidemia. Am J Cardiovasc Drugs 2010;10:11-28.
Fleisher LA, Fleischmann KE, Auerbach AD, Barnason SA, Beckman JA, Bozkurt B, et al.
2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines. J Am Coll Cardiol 2014;64:e77-137.
Kristensen SD, Knuuti J, Saraste A, Anker S, Bøtker HE, Hert SD, et al.
2014 ESC/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: Cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014;35:2383-431.
Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG, et al.
2011 ACCF/AHA guideline for coronary artery bypass graft surgery: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg 2012;143:4-34.
2 Nikis Street, Kifisia, 14561, Athens
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]