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Preoperative Rosuvastatin Protects Patients with Coronary Artery Disease Undergoing Noncardiac Surgery

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Dr Dilip Kumar, Kolkata    04 January 2018

Since the number of people aged >65 years will increase 25-35% over the next 30 years, the number of people with CVD undergoing emergency surgical procedures will increase as well.

Perioperative major adverse cardiovascular and cerebrovascular events (MACCE) continue to be important clinical problems.

Several studies suggest that statins can prevent adverse CV events at both the primary and secondary levels. In recent years, perioperative CV evaluations and CV protection strategies for noncardiac surgery have reduced the incidence of this condition. Strategies include the use of dual antiplatelets, β blockers, ACE inhibitors and statins.

The cholesterol-independent effects of statins can occur immediately after a single dose of these drugs. They lead to an improvement in microvessel coronary circulation and endothelial function, a reduction of thromboembolic events and myocardial protection that translate into early and long-term positive clinical outcomes.

A variety of physiologic perturbations induced by the perioperative status, such as increased sympathetic tone, anemia, pain and abrupt changes in metabolic, hemodynamic and electrolytic parameters may precipitate plaque instability and thrombosis, especially during emergency surgical procedures.

Because the response of plaques to surgery is not predictable, systemic medical therapy with a statin that can stabilize plaques is an attractive option.

Preoperative rosuvastatin reload therapy decreases the incidence of myocardial necrosis and MACCE after noncardiac emergency surgery in patients with stable coronary artery disease on long-term statin therapy.

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