Rational Pharmacotherapy in Cardiology

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Optimization of pharmacotherapy in the preoperative period is the cornerstone of the risk modification of cardiovascular complications in the perioperative period. Particular attention has recently been focused on statins use. Evidence base of this drugs class use in the perioperative period serves as the basis for the development of clinical guidelines. However, the results of large randomized trials of statins are controversial. Ambiguous interpretations of these trials data has resulted in significant differences in the classes of recommendations and levels of evidence. Analysis of results of the basic clinical trials and the guidelines of international and national medical societies on the use of statins in patients with cardiovascular diseases to reduce the risk of cardiac complications in the perioperative period in planned extracardiac surgery is presented.

About the Authors

V. V. Samoylenko
Russian National Research Medical University named after N.I. Pirogov
Russian Federation
Ostrovitianova ul. 1, Moscow, 117997 Russia

O. P. Shevchenko
Russian National Research Medical University named after N.I. Pirogov
Russian Federation
Ostrovitianova ul. 1, Moscow, 117997 Russia

V. I. Burtsev
I.M. Sechenov First Moscow State Medical University
Russian Federation
Trubetskaya ul. 8-2, Moscow, 119991 Russia


1. Kehlet H., Wilmore DW. Multimodal strategies to improve surgical outcome. The American Journal of Surgery 2002; 183: 630-41.

2. Singh N., Augoustides JG. Perioperative protective effects of statins. F1000 Medicine Reports 2010: 2:35.

3. Skrlin S., Hou V. A Review of Perioperative Statin Therapy for Noncardiac Surgery. Seminars in Cardiothoracic and Vascular Anesthesia 2010;14(4): 283-90.

4. Vaughan CJ, Gotto AM Jr, Basson CT. The evolving role of statins in the management of atherosclerosis. J Am Coll Cardiol 2000;35(1):1-10.

5. Ahmed M, Griffiths P. Statins and secondary prevention of coronary heart disease. Br J Community Nurs 2004;9(4):160-5.

6. Sadowitz B, Maier KG, Gahtan V. Basic science review: Statin therapy--Part I: The pleiotropic effects of statins in cardiovascular disease. Vasc Endovascular Surg 2010;44(4):241-51.

7. Sadowitz B, Seymour K, Costanza MJ, Gahtan V. Statin therapy--Part II: Clinical considerations for cardiovascular disease. Vasc Endovascular Surg. 2010 Aug; 44(6):421-33.

8. Pasternak RC, Smith SC Jr, Bairey-Merz CN, et al. ACC/AHA/NHLBI clinical advisory on the use and safety of statins. J Am Coll Cardiol 2002;40(3):567-72.

9. Lindenauer PK, Pekow P, Wang K, et al. Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery. JAMA 2004; 291: 2092-9.

10. Poldermans D, Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation2003; 107: 1848-51.

11. O'Neil-Callahan K, Katsimaglis G, Tepper MR, et al. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study. J Am Coll Cardiol 2005; 45: 336-42.

12. Kertai MD, Boersma E, Westerhout CM, et al. A combination of statins and beta-blockers is independently associated with a reduction in the incidence of perioperative mortality and nonfatal myocardial infarction in patients undergoing abdominal aortic aneurysm surgery. Eur J Vasc Endovasc Surg 2004; 28: 343-52.

13. Landesberg G, Shatz V, Akopnik I, et al. Association of cardiac troponin, CK-MB, and postoperative myocardial ischemia with long-term survival after major vascular surgery. J Am Coll Cardiol 2003; 42: 1547-54.

14. Kennedy J, Quan H, Buchan AM, et al. Statins are associated with better outcomes after carotid endarterectomy in symptomatic patients. Stroke 2005; 36: 2072-6.

15. Ward RP, Leeper NJ, Kirkpatrick JN, et al. The effect of preoperative statin therapy on cardiovascular outcomes in patients undergoing infrainguinal vascular surgery. Int J Cardiol 2005; 104:264-8.

16. McGirt MJ, Perler BA, Brooke BS, et al. 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors reduce the risk of perioperative stroke and mortality after carotid endarterectomy. J Vasc Surg 2005; 42: 829-36.

17. Fleisher LA., Beckman JA., Brown KA et al. ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery. A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). JACC 2007; 50 (17): e159-241.

18. Kapoor AS., Kanji H., Buckingham J., et al. Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies. BMJ 2006;333(7579):1149.

19. Japanese Circulation Society Guidelines for Perioperative Cardiovascular Evaluation and Management for Noncardiac Surgery (2008). Circ J 2011; 75: 989-1009.

20. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg 2004; 39(5):967-75.

21. Schouten O, Boersma E, Hoeks SE, et al. Fluvastatin and perioperative events in patients undergoing vascular surgery. N Engl J Med 2009;361(10):980-9.

22. Dunkelgrun M, Boersma E, Schouten O, et al. Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV). Ann Surg 2009;249(6):921-6.

23. Poldermans D, Bax JJ, Boersma E, et al. Guidelines for preoperative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery. Eur Heart J 2009; 30: 2769-812.

24. Hindler K., Shaw A.D., Samuels J. et al. Improved postoperative outcomes associated with preoperative statin therapy. Anesthesiology 2006; 105(6): 1260-72.

25. Poldermans D. Statins and noncardiac surgery: Current evidence and practical considerations. CCJM 2009;76(4):S79-S83.

26. II Diretriz de Avaliação Perioperatória da Sociedade Brasileira de Cardiologia. Arq Bras Cardiol 2011; 96 (3 supl 1): 1-68.

27. Prise en charge du coronarien qui doit etre opere en chirurgie non cardiaque. Recommendation formalisees d’experts SFAR/SFC. Available at: Accessed by 19.10.2014.

28. National guidelines for the prediction and prevention of cardiac complications extracardiac surgery. Kardiovaskulyarnaya Terapiya i Profilaktika 2011; 10 (6) suppl 3: 1-35. Russian (Национальные рекомендации по прогнозированию и профилактике кардиальных осложнений внесердечных хирургических вмешательств. Кардиоваскулярная Терапия и Профилактика 2011; 10 (6) приложение 3: 1-35).

29. Chopra V., Wesorick D.H., Sussman J.B. et al. Effect of perioperative statins on death, myocardial infarction, atrial fibrillation, and length of stay: a systematic review and meta-analysis. Arch Surg 2012; 147(2): 181-9.

30. Santos JR JCM. Can statins improve outcome in colorectal surgery? Part I. J Coloproctol 2012;32(3): 334-8.

31. Neilipovitz DT., Bryson GL., Taljaard M. STA VaS – Short Term Atorvastatin Regime for Vasculopathic Subjects: a randomized placebo-controlled trial evaluating perioperatuve atorvastatin therapu in noncardiac surgery. Can J Anesth 2012; 59: 527-37.

32. Sanders RD, Nicholson A, Lewis SR, et al. Perioperative statin therapy for improving outcomes during and after noncardiac vascular surgery. Cochrane Database of Systematic Reviews 2013; 7: CD009971.

33. Argalious MY., Dalton JE., Sreenivasalu TS., et al. The Association of Preoperative Statin Use and Acute Kidney Injury After Noncardiac Surgery. Anesth Analg 2013;117:916-23.

34. Erasmus Medical Centre. Report on the 2012 follow-up investigation of possible breaches of academic integrity. Available at: Accessed by 19.10.2014.

35. European Society of Cardiology. Dismissal of Professor Don Poldermans from the Erasmus Medical Center (NL). Available at: Accessed by 19.10.2014.

36. European Society of Cardiology. ESC Statement. Available at: . Accessed by 19.10.2014.

37. Nowbar AN., Cole GD, Shun-Shin MJ, et al. International RCT-based guidelines for use of preoperative stress testing and perioperative beta-blockers and statins in non-cardiac surgery. Int J Cardiol 2014;172(1):138-43.

38. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J 2014; 35: 2383–431.

39. Liakopoulos OJ, Kuhn EW, Slottosch I, Wassmer G,Wahlers T. Preoperative statin therapy for patients undergoing cardiac surgery. Cochrane Database of Systematic Reviews 2012; 4: CD008493 40. Landoni L., Rodseth RN., Santini F., et al. Randomized Evidence for Reduction of Perioperative Mortality. Journal of Cardiothoracic and Vascular Anesthesia 2012; 26(5): 764-72.

For citation:

Samoylenko V.V., Shevchenko O.P., Burtsev V.I. STATINS USE IN THE PERIOPERATIVE PERIOD ACCORDING TO THE EVIDENCE-BASED MEDICINE. Rational Pharmacotherapy in Cardiology. 2014;10(5):548-553. (In Russ.)

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