Statins and anesthesia: dilemma or obviousness? Is there still room for withdrawal of chronic statin therapy before surgery?]

Due to their action on the low-density lipoprotein-cholesterol (LDL-Cholesterol), statins efficiently take part in the treatment of coronary artery disease (CAD). Moreover, they exert various effects (called "pleiotropic") independently of their lipid lowering actions. All of these effects interact with inflammation, thrombosis and vasoconstriction during the perioperative period. However, statins may also increase the risk of rhabdomyolysis, a rare but potentially lethal complication. In this article, we will describe the advantages and disadvantages of statin therapy during the perioperative period. Although in the past, withdrawal of statins was recommended before anesthesia, there is now evidence that statins must be continued or even must be introduced before surgery. We will try to identify relevant situations were statins are still under-prescribed before surgery.