| Summary: | Hydroxymethylglutaryl-CoA reductase inhibitors, better known as statins have come a long way in the recent years, not just in perioperative cardiac protection but also as potential agents for the critically ill patient in intensive care.
To review the large body of literature on the pleiotropic effects of statins and to highlight their role not just in the stabilisation of atherosclerotic plaques but also improved outcomes in sepsis. PubMed was searched using "perioperative", "cardiac", "critically ill", "statins" and combinations of these terms as keywords. The reference lists of relevant articles were further reviewed to identify additional citations.
Principal findings: The underlying pharmacology, cellular and metabolic responses to statin therapy are elucidated. The duration and timing of statin therapy in terms of perioperative practice is presented along with evidence regarding the utility and safety of peri-operative statin therapy. The indications for peri-operative statin therapy especially for vascular surgical patients and the need for continuation post operatively are highlighted. Potential roles in sepsis and septic shock though in their infancy as of now are reviewed and outcomes presented. Recommendations for peri-operative statin therapy are made with the need for more work before extrapolation to the clinical scenario.
Perioperative statin therapy seems to be associated with a survival benefit, with a variable effect on postoperative cardiovascular morbidity. The available evidence also suggests that, there may be a benefit from including statins in the therapy for treatment of sepsis. Larger prospective, randomized clinical trials are needed to confirm these observations and to determine the optimal timing and duration of statin therapy in the perioperative setting.
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