Statins for all: the new premed?

Area of Science:

• Cardiology
• Pharmacology
• Vascular Biology

Background:

• Statins are widely prescribed and frequently used by surgical patients.
• Evidence suggests statins provide benefits beyond lipid reduction, including mitigating perioperative cardiac events and sepsis.
• Understanding the cellular mechanisms of these effects is crucial for perioperative care.

Purpose of the Study:

• To review the cellular mechanisms underlying statins' non-lipid-lowering effects.
• To examine the clinical evidence for statin use in the perioperative period.
• To clarify the current recommendations for perioperative statin therapy.

Main Methods:

• Literature review of cellular mechanisms of statin action.
• Analysis of clinical studies on perioperative statin use.
• Evaluation of evidence for continuing versus initiating statin therapy around surgery.

Main Results:

• Statins influence vascular nitric oxide (NO) pathways, affecting inducible and endothelial NO synthase.
• Clinical data suggest continued statin use in the perioperative period is beneficial.
• Evidence supporting the prophylactic initiation of statins before surgery is limited and lacks robust controlled trials.

Conclusions:

• Statins possess pleiotropic effects beneficial in the perioperative setting.
• Continuation of existing statin therapy during surgery is supported by strong evidence.
• Prophylactic use of statins perioperatively requires further investigation through prospective controlled studies.