A reply

Abstract

Thank you to Yates and colleagues who appropriately question the wisdom of initiating statin therapy in high-risk patients prior to surgery, especially as the prospective evidence is sparse [1]. However, this question is currently a serious ethical problem for anaesthetists. Is it appropriate to withhold statin therapy from patients in whom it is medically indicated, because they are about to undergo surgery? There is currently little evidence to suggest that the common comorbidities of vascular patients are a contra-indication to statin therapy, or that peri-operative statin therapy in these patients will result in increased adverse drug events [2]. Is it then ethical to deny these patients statin therapy at a time when cardiovascular morbidity and mortality is increased? I agree that a prospective study is needed. However, I believe that recruitment for this study may be difficult. Potential subjects will have to be made aware of the facts presented above. It is likely that as a result a number of patients will choose to opt out of the study, so as to guarantee statin administration in the peri-operative period. In addition, the number needed for this study would be larger than that suggested by Yates and colleagues, as it is generally accepted that the risk reduction reported in the statin meta-analyses overestimates the utility of peri-operative statins [2]. Finally, while the data presented by Yates and colleagues is important, it is difficult to draw any conclusions as it is underpowered to address the utility of peri-operative statin therapy for these high-risk patients. However, it is data of this nature that should be gathered in a central database to better inform peri-operative decision making [2], until such time as appropriate prospective studies are published that clarify the issues raised by Yates and colleagues.