A response to ‘Statin therapy: a potentially useful peri‐operative intervention in patients with cardiovascular disease’

Abstract

Biccard and colleagues [1] have reviewed the use of peri-operative statins. Their recommendations are based on 10 trials, nine of which are retrospective and two were in the context of cardiac surgery. The only prospective study quoted in this review describing the efficacy of statins, is by Durazzo et al. [2]. In this study 100 patients were randomly allocated to receive atorvastatin 20 mg or placebo. Therapy was initiated 45 days prior to surgery and continued for at least 2 weeks postoperatively. Ninety of the 100 patients underwent vascular surgery. It seems that the peri-operative use of statins in patients undergoing vascular surgery is promising. However, there is insufficient information about the use of statins in patients not having vascular or cardiac surgery, the optimal dose and duration of therapy or to confirm the effectiveness of stains. It may be prudent to wait for the results of more conclusive trials such as the DECREASE IV study [3] in which 6000 moderate to high risk patients undergoing non-cardiac surgery are being randomly allocated to receive beta-blockers, statins, or combination therapy. The results of this trial will be presented in spring 2008 [4]. The peri-operative recommendations also make reference to the Lee's Revised Cardiac Risk Index [5]. This was developed for elective non-cardiac surgery. Of the entire study population of 2893, only a very small percentage (3.8%) underwent vascular surgery. This predictive model has been validated in predicting cardiac complications. More recently Kertai et al. [6] have proposed a ‘customised probability model’. This model may be more applicable to vascular patients; it includes emergency surgery and substantially improves the predictive performance of the Lee index. The model estimates all-cause mortality. I suggest using this model when considering the peri-operative use of statins.