Archives of Anesthesiology and Critical Care 2015. 1(4):130-133.

The Perioperative Effects of Statins in Non Cardiac Surgeries
Atieh Rezaeefar, Reza Shariat Moharari, Atabak Najafi, Mohammad Reza Khajavi

Abstract


Background: Statins (3-Hydroxy-3-methylglutarylcoenzyme-A (HMG-CoA) reductase inhibitors) decrease cardiovascular mortality and morbidity. This article reviews the role of perioperative statins in non cardiac surgery.

Methods: A literature review was done on all English published articles till February 2015 about this subject using pubmed. Then the reference list of relevant articles was reviewed for additional resources.

Results: Current evidence shows that not only statins decrease perioperative morbidity and mortality in patients undergoing non cardiac surgery, but also they seem safe during perioperative period.

Conclusion: A properly designed randomized control trial should be performed to assess the perioperative benefits of statins in non cardiac surgery.


Keywords


statins; non cardiac surgery; perioperative periods

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References


Priebe HJ. Triggers of perioperative myocardial ischemia and infarction. Br J Anaesth. 2004; 93(1):9-20.

Badner NH, Knill RL, Brown JE, Novick TV, Gelb AW. Myocardial infarction after noncardiac surgery. Anesthesiology. 1998; 88(3):572-8.

Fleischmann KE, Goldman L, Young B, Lee TH. Association between cardiac and noncardiac complications in patient undergoing noncardiac surgery: outcomes and effects on length of stay. Am J Med. 2003; 115(7):515-20.

Amar D, Zhang H, Roistacher N. The incidence and outcome of ventricular arrhythmias after noncardiac thoracic surgery. Anesth Analg. 2002; 95(3):537-43.

Passman RS, Gingold DS, Amar D, Lloyd-Jones D, Bennett CL, Zhang H, et al. Prediction rule for atrial fibrillation after major noncardiac thoracic surgery. Ann Thorac Surg. 2005; 79(5):1698-703.

Lee TH, Marcantonio ER, Mangione CM, Thomas EJ, Polanczyk CA, Cook EF, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999; 100(10):1043-9.

Poldermans D, Boersma E, Bax JJ, Thomson IR, van de Ven LL, Blankensteijn JD, et al. The effect of bisoprolol on perioperative mortality and myocardial infarction in high-risk patients undergoing vascular surgery. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group. N Engl J Med. 1999; 341(24):1789-94.

Lindenauer PK, Fitzgerald J, Hoople N, Benjamin EM. The potential preventability of postoperative myocardial infarction: underuse of perioperative b-adrenergic blockade. Arch Intern Med. 2004; 164(7):762-6.

Boushra NN, Muntazar M. The role of statins in reducing perioperative cardiac risk: physiologic and clinical perspectives. Can J Anesth. 2006; 53(11):1126-47.

Mangano DT, Hollenberg M, Fegert G, Meyer ML, London MJ, Tubau JF, et al. Perioperative myocardial ischemia in patients undergoing noncardiac surgery: incidence and severity during the 4 day perioperative period. The Study of Perioperative Ischemia (SPI) Research Group. J Am Coll Cardiol 1991; 17(4):851-7.

Poldermans D, Boersma E, Bax JJ, Kliffen M, van Urk H, van de Ven L, et al. Correlation of location of acute myocardial infarct after noncardiac vascular surgery with preoperative dobutamine echocardiographic findings. Am J Cardiol. 2001; 88(12):1413-4.

Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007; 356(15):1503-16.

Abrams J. Clinical practice Chronic stable angina. N Engl J Med. 2005; 352(24):2524-33.

Chan YC, Cheng SW, Irwin MG. Perioperative Use of Statins in noncardic surgery. Vasc Health Risk Manag. 2008; 4(1): 75–81.

Zhou Q, Liao JK. Pleiotropic effects of statins: basic research and clinical perspectives. Circ J. 2010; 74(5): 818–826.

Illingworth DR, Tobert JA. HG-CoA reductase inhibitors. Adv Protein Chem. 2001; 56:77-114.

Biccard BM. A perioperative statin update for non-cardiac surgery: Part I: The effects of statin therapy on atherosclerotic disease and lessons learned from statin therapy in medical (non-surgical) patients. Anaesthesia. 2008; 63(1):52-64.

Zhou Q, Liao JK. Statins and cardiovascular diseases: from cholesterol lowering to pleiotropy. Curr Pharm Des. 2009; 15(5):467-78.

Skrlin S, Hou V. A review of perioperative statin therapy for noncardiac surgery. Semin Cardiothorac Vasc Anesth. 2010; 14:283-90.

Ashen MD, Blumenthal RS. Clinical practice Low HDL cholesterol levels. N Engl J Med 2005; 353(12):1252-60.

Scandinavian Simvastatin Survival Study Group Randomised trial

of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S) Lancet1994; 344(8934):1383-9.

Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels, Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996; 335(14):1001-9.

LIPID Study Group.Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med. 1998; 339(19):1349-57.

Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of antioxidant vitamin supplementation in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360(9326):23-33.

ALLHAT. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA. 2002; 288(23):2998-3007.

Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002; 360(9346):1623-30.

Poldermans D, Bax JJ, Kertai MD, Krenning B, Westerhout CM, Schinkel AF, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003; 107(14):1848-51.

Durazzo AE, Machado FS, Ikeoka DT, De Bernoche C, Monachini MC, Puech-Leão P, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004; 39(5):967-75.

Lindenauer PK, Pekow P, Wang K, Gutierrez B, Benjamin EM. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA. 2004; 291(17):2092-9.

Noordzij PG, Poldermans D, Schouten O, Schreiner F, Feringa HH, Dunkelgrun M, et al. Beta-blockers and statins are individually associated with reduced mortality in patients undergoing noncardiac, nonvascular surgery. Coron Artery Dis. 2007; 18(1):67-72.

B.A.de Waal, M.P.Buise. Perioperative statin therapy in patients at high risk for cardiovascular morbidity undergoing surgery. British J Anesthesia. 2015; 114:44-52.

Guay J, Ochroch E.A. Effects of adding statins before surgery on mortality and major Morbidity. J Cardiothorac Vasc Anesth. 2014; 28(2):255-66.

Antoniou GA, Hajibandeh S, Hajibandeh S, Vallabhaneni SR, Brennan JA, Torella F. Meta-analysis of the effects of statins on perioperative outcomes in vascular and endovascular surgery. J Vasc Surg. 2015; 61(2):519-532.

Schouten O, van Laanen JH, Boersma E, Vidakovic R, Feringa HH, Dunkelgrün M, et al. Statins are associated with a reduced infrarenal abdominal aortic aneurysm growth. Eur J Vasc Endovasc Surg. 2006; 32(1):21-6.

Schouten O, Kok NF, Boersma E, Bax JJ, Feringa HH, Vidakovic R, et al. Effects of statins on renal function after aortic cross clamping during major vascular surgery. Am J Cardiol. 2006; 97(9):1383-5.

Henke PK, Blackburn S, Proctor MC, Stevens J, Mukherjee D, Rajagopalin S, et al. Patients undergoing infrainguinal bypass to treat atherosclerotic vascular disease are underprescribed cardioprotective medications: effect on graft patency, limb salvage, and mortality. J Vasc Surg. 2004; 39(2): 357–363.

Ward RP, Leeper NJ, Kirkpatrick JN, Lang RM, Sorrentino MJ, Williams KA. The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular surgery. IntJ Cardiol. 2005; 104(3):264-8.

LaMuraglia GM, Stoner MC, Brewster DC, Watkins MT, Juhola KL, Kwolek C, et al. Determinants of carotid endarterectomy anatomic durability: effects of serum lipids and lipid-lowering drugs. J Vasc Surg. 2005; 41(5):762-8.

Kennedy J, Quan H, Buchan AM, Ghali WA, Feasby TE. Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients. Stroke. 2005; 36(10):2072-6.

Iannuzzi J.C, Rickles AS, Kelly KN2, Rusheen AE2, Dolan JG3, Noyes K, et al. perioperative pleiotropic statin effects in general surgery. Surgery. 2014; 155(3):398-407.

Blum A, Shamburek R. The pleiotropic effects of statins on endothelial function, vascular inflammation, immunomodulation and thrombogenesis. Atherosclerosis. 2009; 203(2):325-30.

Vasa M, Fichtlscherer S, Adler K, Aicher A, Martin H, Zeiher AM, et al. Increase in circulating endothelial progenitor cells by statin therapy in patients with stable coronary artery disease. Circulation. 2001; 103(24):2885-90.

Zeki AA, Franzi L, Last J, Kenyon NJ. Simvastatin inhibits airway hyperreactivity: implications for the mevalonate pathway and beyond. Am J Respir Crit Care Med. 2009; 180(8):731-40.

McGown CC, Brookes ZL. Benefi cial effects of statins on the microcirculation during sepsis: the role of nitric oxide. Br J Anaesthsia. 2007; 98(2):163-75.

Schouten O, Boersma E, Hoeks SE, Benner R, van Urk H, van Sambeek MR, et al. Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echocardiography Study Group: Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med. 2009; 361(10):980-9.

Antoniades C, Demosthenous M, Reilly S, et al. Myocardial redox state predicts in hospital clinical outcome after cardiac surgery effects of short-term preoperative statin treatment. J Am Coll Cardiol. 2012; 59(1):60-70.

Lalouschek W, Lang W, Greisenegger S, Mullner M, Vienna Stroke Study Group. Determination of lipid profiles and use of statins in patients with ischemic stroke or transient ischemic attack. Stroke. 2003; 34(1):105-10.

Grodzinska L, Starzyk D, Bieron K, Goszcz A, Korbut R. Simvastatin effects in normo and hypercholesterolaemic patients with peripheral arterial occlusive disease: a pilot study. Basic Clin Pharmacol Toxicol. 2005; 96(6):413-9.

Hillis LD, Smith PK, Anderson JL. ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery:executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011; 124:2610-2642.

Deedwania PC, Hunninghake DB, Bays HE, Jones PH, Cain VA, Blasetto JW, et al. Effects of rosuvastatin, atorvastatin, simvastatin, and pravastatin on atherogenic dyslipidemia in patients with characteristics of the metabolic syndrome. Am J Cardiol. 2005; 95(3):360-6.

Bybee KA, Wright RS, Williams BA, Murphy JG, Holmes DR Jr, Kopecky SL. Effect of concomitant or very early statin administration on in-hospital mortality and reinfarction in patients with acute myocardial infarction. Am J Cardiol. 2001; 87(6):771-4.

John S, Schneider MP, Delles C, Jacobi J, Schmieder RE. Lipid-independent effects of statins on endothelial function and bioavailability of nitric oxide in hypercholesterolemic patients. Am Heart J. 2005; 149(3):473.

Wassmann S, Faul A, Hennen B, Scheller B, Bohm M, Nickenig G. Rapid effects of 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition on coronary endothelial function. Circ Res. 2003; 93(9):98-103.

Le Manach Y, Godet G, Coriat P, Martinon C, Bertrand M, Fléron MH, et al. The impact of postoperative discontinuation or continuation of chronic statin therapy on cardiac outcome after major vascular surgery. Anesth Analg. 2007; 104(6):1326-33.

Feringa HH, Bax JJ, Schouten O, Poldermans D. Protecting the heart with cardiac medication in patients with left ventricular dysfunction undergoing major noncardiac vascular surgery. Semin Cardiothorac Vasc Anesth. 2006; 10(1):25-31.

Omar MA, Wilson JP, Cox TS. Rhabdomyolysis and HMG-CoA reductase inhibitors. Ann Pharmacother. 2001; 35(9):1096-107.

Ose L, Davidson MH, Stein EA. Lipid altering efficacy and safety of simvastatin 80 mg: long term experience in a large group of patients with hypercholesterolemia. World Wide Expanded Dose Simvastatin Study Group. Clin Cardiol. 2000; 23(1):39-46.

Laisalmi-Kokki M, Tolonen K, Miettinen H, Kokki H. Perioperative chronic use of statins and the risk of muscle complaints in patients undergoing Knee and hip endoprosthesis surgery. J Clin Anesth. 2010; 22(2):81-7.

Schouten O, Kertai MD, Bax JJ, Durazzo AE, Biagini E, Boersma E, et al. Safety of perioperative statin use in high-risk patients undergoing major vascular surgery. Am J Cardiol. 2005; 95(5):658-60.


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