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BJA Advance Access originally published online on June 5, 2009
British Journal of Anaesthesia 2009 103(1):99-107; doi:10.1093/bja/aep149
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Statins for all: the new premed?

Z. L. S. Brookes, C. C. McGown and C. S. Reilly*

Microcirculation Research Group, School of Medicine and Biomedical Sciences, Royal Hallamshire Hospital, University of Sheffield, K Floor, Beech Hill Road, Sheffield S10 2RX, UK

* Corresponding author. E-mail: c.s.reilly{at}sheffield.ac.uk

The use of statins is widespread and many patients presenting for surgery are regularly taking them. There is evidence that statins have beneficial effects beyond those of lipid lowering, including reducing the perioperative risk of cardiac complications and sepsis. This review addresses the cellular mechanisms by which statins may produce these effects. Statins appear to have actions on vascular nitric oxide through the balance of inducible and endothelial nitric oxide synthase. The clinical evidence for these benefits is also briefly reviewed with the objective of clarifying the current status of statin use in the perioperative period. There is reasonably strong evidence that patients already taking statins should continue on them perioperatively. However, the evidence for the prophylactic use of statins perioperatively is weak and lacks prospective controlled studies.

Keywords: complications, sepsis; heart, ischaemia; inhibitors, reductase, hydroxymethylglutaryl-CoA; nitric oxide; nitric oxide synthase; pharmacology, statins


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