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Evidence summaries

Perioperative Statin Therapy during and after Noncardiac Vascular Surgery

There is insufficient evidence on benefits of perioperative use of statins for noncardiac vascular surgery. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (unclear allocation concealment), and by imprecise results (few patients and outcome events).

Summary

A Cochrane review [Abstract] 1 included 6 studies with a total of 399 subjects, but the largest eligible study was excluded because of concerns about its validity. Study populations were statin naive, which led to a considerable loss of eligible participants. Five studies compared statin use with placebo or standard care. Pooled results within 30 days of surgery from 3 studies are shown in table T1.

Perioperative statins versus placebo or no treatment.

OutcomeParticipants(studies)Illustrative comparative risks (95% CI)Relative risk (95% CI)
Assumed risk (control)Corresponding risk (statin)
All-cause mortality178(3)40 per 100029 per 1000(12 to 70)0.73 (0.31 to 1.75)
Death from cardiovascular causes*178(3)30 per 100031 per 1000(2 to 486)1.05 (0.07 to 16.2)
Non-fatal myocardial infarction178(3)40 per 100019 per 1000(6 to 61)0.47 (0.15 to 1.52)
Non-fatal stroke/TIA178(3)10 per 10002 per 1000(0 to 22)0.24 (0.03 to 2.25)
* Only one death in each group was from cardiovascular causes
Several studies reported muscle enzyme levels as safety measures, but only 3 (n=188) reported explicitly on clinical muscle syndromes, with 7 events reported and no significant difference found between statin users and controls (RR 0.94, 95% CI 0.24 to 3.63). The only participant-reported outcome was nausea in one small study, with no significant difference in risk between groups.

Clinical comments

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