The case for statin use to reduce perioperative adverse cardiovascular and cerebrovascular events

Abstract

Ischaemic heart disease and stroke are the leading causes of death worldwide at 119 per 100,000 and 85 per 100,000 population. For the USA, heart disease is leading cause of death at 165 per 100,000 population. In developed countries, strokes and acute myocardial infarction in the general population have fallen from smoking reduction, lifestyle modifications and therapeutic interventions including statins. In a population-based stroke study in the UK involving primary care practices, of in-hospital strokes 90% were ischaemic, and 37% occurred within 1 week of an operation. Approximately 50% of the patients were not on a statin. In the UK, there is a national screening initiative for the prevention of atherosclerotic cardiovascular disease (ASCVD) offered to people aged 40-74 yr old. The QRISK3 tool calculates the risk of developing heart disease or stroke over 10 yr, from which recommendations are made on interventions for the prevention of ASCVD up to age 84 yr, with similar screening and assessment tools in Europe and the US. If the QRISK3 score tool for calculating cardiovascular risk is considered sufficiently robust for population screening in primary care, should anaesthetists not use the same screening for secondary care? We present a case for statin use over the perioperative period, to reduce early vascular adverse events based on statins' early pleiotropic actions, using the primary care QRISK tool for screening of ASCVD risk.

Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

“…24 Despite these multiple beneficial actions, up to 50% of patients may not be on routine statin treatment. 25,26 In addition to reducing perioperative/periprocedural and long-term stroke/MI/death rates, statins have a beneficial effect on several other potential complications of carotid interventions. [27][28][29][30][31] For example, there is evidence that statins are associated with a reduced incidence of venous thromboembolism 27,28 as well as the development of contrast-induced nephropathy 29,30 in carotid patients undergoing CEA/CAS.…”