Intended for healthcare professionals


Strength of evidence for perioperative use of statins to reduce cardiovascular risk: systematic review of controlled studies

BMJ 2006; 333 doi: (Published 30 November 2006) Cite this as: BMJ 2006;333:1149
  1. Anmol S Kapoor, postgraduate trainee1,
  2. Hussein Kanji, postgraduate trainee2,
  3. Jeanette Buckingham, medical librarian3,
  4. P J Devereaux, assistant professor4,
  5. Finlay A McAlister, associate professor1
  1. 1Division of General Internal Medicine, University of Alberta, 8440 112 Street, Edmonton, AB, Canada T6G 2R7
  2. 2Department of Cardiovascular Surgery, University of Alberta
  3. 3John W Scott Health Sciences Library, University of Alberta
  4. 4Department of Medicine, Clinical Epidemiology, and Biostatistics, McMaster University, Hamilton, Canada
  1. Correspondence to: F A McAlister finlay.mcalister{at}
  • Accepted 22 September 2006


Objective To determine the strength of evidence underlying recommendations for use of statins during the perioperative period to reduce the risk of cardiovascular events.

Design Systematic review of studies with concurrent control groups.

Data sources Four electronic databases, the references of identified studies, international experts on perioperative medicine, and the authors of the primary studies.

Review methods Two reviewers independently extracted data from studies that reported acute coronary syndromes or mortality in patients receiving or not receiving statins during the perioperative period.

Main outcome measure Random effects summary odds ratios for death or acute coronary syndrome during the perioperative period.

Results 18 studies—two randomised trials (n=177), 15 cohort studies (n=799 632), and one case-control study (n=480)—assessed whether statins provide perioperative cardiovascular protection; 12 studies enrolled patients undergoing non-cardiac vascular surgery, four enrolled patients undergoing coronary bypass surgery, and two enrolled patients undergoing various surgical procedures. In the randomised trials the summary odds ratio for death or acute coronary syndrome during the perioperative period with statin use was 0.26 (95% confidence interval 0.07 to 0.99) and the summary odds ratio in the cohort studies was 0.70 (0.57 to 0.87). Although the pooled cohort data provided a statistically significant result, statins were not randomly allocated, results in retrospective studies were larger (odds ratio 0.65, 0.50 to 0.84) than those in the prospective cohorts (0.91, 0.65 to 1.27), and dose, duration, and safety of statin use was not reported.

Conclusion The evidence base for routine administration of statins to reduce perioperative cardiovascular risk is inadequate.


  • Embedded Image
    References w1-w18 are on

  • We thank J Kennedy, D Poldermans, MS Conte, G Landesberg, and D Amar for providing additional unpublished information about their studies.

  • Contributors: ASK and HK contributed equally to the study. ASK, HK, and FAM conceived and designed the study. JB carried out the literature search. ASK, HK, and FAM reviewed the literature search and extracted all study data. FAM wrote the first draft of the paper and all authors contributed to subsequent drafts. FAM is guarantor.

  • Funding: This project was unfunded; FAM is supported by a health scholar award from the Alberta Heritage Foundation for Medical Research, a new investigator award from the Canadian Institutes of Health Research, and the Merck Frosst/Aventis chair in patient health management at the University of Alberta. PJD is supported by a new investigator award from the Canadian Institutes of Health Research.

  • Competing interests: None declared.

  • Ethical approval: Not required.

View Full Text