Abstract
The aim of this literature review is to assess the experimental and clinical evidence regarding potential neuroprotective effects of statins and their possible perioperative benefit. Statins are drugs used to control cholesterol disorders and prevent cardiovascular diseases by four mechanisms: improvement of endothelial function, modulation of inflammatory responses, maintenance of plaque stability, and prevention of thrombus formation. It is possible that these various effects may also be neuroprotective. The anti-inflammatory effects of statins on endothelial cell mechanisms are better understood than their role in neuroprotection or tumoral apoptosis and evidence is only just emerging that statins may be beneficial. Data regarding perioperative use of statins in neurosurgery is scarce, controversial and inconclusive since there is a lack of convincing randomized, prospective clinical trials. More trials in humans are needed to determine whether statins could contribute to the current management of neurosurgical diseases. Not much is known about utilizing statins as a prophylactic treatment and some would probably advocate that we should be treating ‘at risk’ patients with statins perioperatively or at least it is important to try to put this into a clinical perspective.
Highlights
The aim of this literature review is to assess the experimental and clinical evidence regarding potential neuroprotective effects of statins and their possible perioperative benefit
Since elevated serum cholesterol levels have been associated with cardiovascular diseases [1], statins are known to be effective in decreasing mortality and morbidity in patients with cardiovascular disease
Statins are currently recommended for patients at high risk of developing heart disease and they are known to lower cholesterol, decrease the number of cardiac events, and reduce the risk of stroke [2]
Summary
The aim of this literature review is to assess the experimental and clinical evidence regarding potential neuroprotective effects of statins and their possible perioperative benefit. Statins are drugs primarily used to control cholesterol disorders and prevent cardiovascular disease. They inhibit hydroxymethylglutaryl–coenzyme A (HMGCoA) reductase, an enzyme that plays a central role in the production of cholesterol in the liver (Figure 1). Since elevated serum cholesterol levels have been associated with cardiovascular diseases [1], statins are known to be effective in decreasing mortality and morbidity in patients with cardiovascular disease. Statins are currently recommended for patients at high risk of developing heart disease and they are known to lower cholesterol, decrease the number of cardiac events, and reduce the risk of stroke [2]. Improvement of endothelial function, modulation of inflammatory responses, maintenance of plaque stability, and Acetoacetyl-CoA β-Hydroxy-β-methylglutaryl-CoA
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