Statins
The 2024 AHA/ACC guideline recommends continuing statin therapy in patients already taking it. If a patient meets an established long-term indication for a statin, perioperative initiation should be part of ongoing cardiovascular prevention.
Why continuation matters
Statin withdrawal around surgery has been associated with adverse cardiovascular events in observational studies. No intravenous formulation is available, so prolonged interruption is more likely in patients who cannot take oral medicines after surgery.
Long-term prevention and perioperative initiation
ESC 2022 advises against routine perioperative initiation of statins solely because surgery is planned. Where a long-term indication already exists, it supports considering treatment around surgery, particularly for higher-risk procedures. The indication and expected ongoing treatment matter.
Practical application
- Established statin therapy is generally included in the perioperative continuation plan, unless an individual contraindication or clinical concern changes that plan.
- After an interruption, resumption is generally considered when enteral administration is feasible and clinically appropriate.
- If interruption of oral intake is prolonged, pharmacy advice can help assess whether a suitable formulation can be given through an enteral tube. Suitability depends on the specific product and route.
- The preoperative review may identify an unmet long-term indication for a statin that can be discussed with the usual treating clinician.
Sources
- 2024 AHA/ACC guideline for perioperative cardiovascular management for non-cardiac surgery
- ESC guideline: cardiovascular assessment and management for non-cardiac surgery (2022)