Anti-inflammatory effects of perioperative statin therapy

Wilton A Van Klei,Wolfgang F Buhre

doi:10.1007/s12630-012-9703-y

Wilton A Van Klei, Wolfgang F Buhre

Open Access

https://doi.org/10.1007/s12630-012-9703-y

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Abstract

Perioperative physicians seek to reduce the risk of adverse perioperative events, focusing in particular on adverse cardiovascular events such as myocardial infarction (MI) and cardiac death. To this aim, extensive and often invasive intra- and postoperative hemodynamic monitoring have become the standard of care. Obviously, monitoring in itself does not prevent adverse events as over 5% of high-risk surgical patients still suffer from perioperative myocardial ischemia and infarction.1,2 Therefore, efforts have been undertaken to reduce the risk of perioperative MI by risk stratification during preoperative assessment and subsequent initiation of preventive medical treatment early before surgery in patients identified as high-risk.3 Preventive medical treatments that have been investigated include preoperative initiation of beta-blockers, alpha2-agonists, acetylsalicylic acid, and statins.2-6 The effect of initiating prophylactic treatment with beta-blockers to reduce perioperative MI seems counterbalanced by the occurrence of other major adverse events, such as stroke and death.2 The results of studies evaluating perioperative prophylactic treatment of high-risk patients with acetylsalicylic acid and alpha2-agonists seem encouraging, but current evidence is insufficient to advocate their widespread use.4 Statins were considered another promising class of drugs in the prevention of perioperative MI among high-risk surgical patients with cardiovascular risk factors.5,6

Highlights

Perioperative physicians seek to reduce the risk of adverse perioperative events, focusing in particular on adverse cardiovascular events such as myocardial infarction (MI) and cardiac death
Monitoring in itself does not prevent adverse events as over 5% of highrisk surgical patients still suffer from perioperative myocardial ischemia and infarction.[1,2]
Efforts have been undertaken to reduce the risk of perioperative MI by risk stratification during preoperative assessment and subsequent initiation of preventive medical treatment early before surgery in patients identified as high-risk.[3]

Summary

Introduction

Perioperative physicians seek to reduce the risk of adverse perioperative events, focusing in particular on adverse cardiovascular events such as myocardial infarction (MI) and cardiac death. Neilipovitz et al studied whether a clinically relevant effect on inflammation, as assessed by pre- and postoperative C-reactive protein (CRP), could be detected if statins were initiated shortly before surgery.[13] In this issue of the Journal, they report the results of an interesting study designed to assess the anti-inflammatory effect of short-term atorvastatin use in patients at high cardiac risk undergoing noncardiac surgery, but without previous statin administration.

Results

Conclusion