Perioperative statin therapy: understanding the evidence in a Bayesian context

Excerpt

Over the past decade, there has been a marked increase in the level of interest in studying different pharmacologic approaches to reduce the perioperative cardiovascular risk for noncardiac surgery.1 The focus of much of the work has been on two specific classes of drugs: beta-blockers and statins. There is widespread consensus that these drugs should be continued perioperatively in those patients already taking them, but there is a great deal of controversy regarding initiation of these agents immediately prior to surgery. This controversy has been further heightened by conflicting study results and recent questions regarding the quality of some of the related randomized-controlled trials.2 In attempting to determine the optimal strategy, it is important to understand both the protocols utilized in the studies and the underlying pharmacologic basis for therapy. In this context, the study by Neilipovitz et al. in this issue of the Journal examines the short-term effects of an atorvastatin regimen for vascular-prone subjects and contributes significantly to the literature.3 …