The quality of evidence is downgraded by study limitations (unclear allocation concealment), and by imprecise results (few patients and outcome events).
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.
| Outcome | Participants(studies) | Illustrative comparative risks (95% CI) | Relative risk (95% CI) | |
|---|---|---|---|---|
| Assumed risk (control) | Corresponding risk (statin) | |||
| * Only one death in each group was from cardiovascular causes | ||||
| All-cause mortality | 178(3) | 40 per 1000 | 29 per 1000(12 to 70) | 0.73 (0.31 to 1.75) |
| Death from cardiovascular causes* | 178(3) | 30 per 1000 | 31 per 1000(2 to 486) | 1.05 (0.07 to 16.2) |
| Non-fatal myocardial infarction | 178(3) | 40 per 1000 | 19 per 1000(6 to 61) | 0.47 (0.15 to 1.52) |
| Non-fatal stroke/TIA | 178(3) | 10 per 1000 | 2 per 1000(0 to 22) | 0.24 (0.03 to 2.25) |
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.
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