Why and how to use statins in the perioperative period?

There is growing evidence that statin use is associated with a reduction in perioperative morbidity and mortality. Statins inhibit 3-hydroxy3-methylglutaryl coenzyme A reductase, a mechanism that effectively reduces low-density lipoprotein cholesterol. Numerous randomized controlled studies have shown that this intervention effectively impedes the development of atherosclerosis and attenuates cardiovascular risk in nonsurgical patients. Interestingly, at relatively high doses statins also improve short term outcome in patients with acute coronary events. The latter is more difficult to relate to the change in circulating lipoproteins and triglycerides. Similarly, the proposed beneficial effects of statins in the perioperative period are unlikely to result only from a modification in lipid profile and other interesting explanations have been forwarded.