Abstract
Introduction: There is good evidence that perioperative statin therapy is cardioprotective and reduces postoperative complications after cardiac surgery in statin-naive patients. However, most cardiac surgical patients will already be established on chronic statin therapy. Clinical and experimental evidence suggests that additional doses of statin treatment in this setting may be able to provide further benefit. Methods: MEDLINE using the OVID interface was searched to December 2019 for randomised controlled trials of statin reloading in cardiac surgery. Results: 932 papers were identified of which 5 met eligibility criteria. No study demonstrated a significant difference in clinical endpoints. One study found a 7.3% absolute risk reduction in the odds of postoperative atrial fibrillation which did not reach significance. Two further studies reported a reduction in proinflammatory cytokines. One of these also demonstrated decreased markers of cardiac and renal injury. Discussion: Although statin reloading is cardioprotective in animal models, there is little translational evidence in humans. Current evidence suggests a protective effect of perioperative statin therapy for atrial fibrillation. However, this was not replicated by any of the reloading trials. Furthermore, studies were small trials with significant heterogeneity in both baseline and intervention statin regimens. We conclude that the current evidence base does not support additional statin therapy in patients on chronic statin treatment scheduled for cardiac surgery.
Highlights
There is good evidence that perioperative statin therapy is cardioprotective and reduces postoperative complications after cardiac surgery in statin-naive patients
We conclude that the current evidence base does not support additional statin therapy in patients on chronic statin treatment scheduled for cardiac surgery
The aim of this paper is to investigate whether additional preoperative doses of statin medication in patients already established on chronic statin treatment can reduce postoperative complications in cardiac surgery
Summary
There is good evidence that perioperative statin therapy is cardioprotective and reduces postoperative complications after cardiac surgery in statin-naive patients. Current evidence suggests a protective effect of perioperative statin therapy for atrial fibrillation This was not replicated by any of the reloading trials. Beyond their role in the primary and secondary prevention of cardiovascular disease, statins exert a host of beneficial cholesterolindependent pleiotropic effects These include vasodilatation, attenuation of inflammation and oxidative stress, platelet inhibition, anticoagulation and promotion of endothelial function [1, 3]. Many of these effects occur within 24 hours of statin initiation and before any significant reduction in serum cholesterol levels. These may act to oppose sympathetically mediated surgical stress and myocardial injury from the ischaemia reperfusion sequence
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