Perioperative β-blocker and statin therapy

PURPOSE OF REVIEW: Perioperative β-blockade and statin therapy have been advocated to reduce cardiac risk of noncardiac surgery. This review evaluates recent articles published on the cardioprotective effects of perioperative therapy with these medications. RECENT FINDINGS: Initial studies evaluating β-blocker therapy during the perioperative period suggested that β-blockers may be beneficial in reducing cardiac deaths and myocardial infarctions. Later studies and recent meta-analyses, however, are less favorable and suggest that β-blockers may be associated with increased incidence of bradycardia and hypotension. One randomized trial and several cohort studies have found a significant reduction in cardiovascular complications with perioperative statin therapy. Additionally, statin withdrawal is associated with increased postoperative cardiac risk. SUMMARY: Based upon the available evidence and guidelines, patients currently taking β-blockers should continue these agents. Patients undergoing vascular surgery who are at high cardiac risk should also take β-blockers. The question remains regarding the best protocol to initiate perioperative β-blockade. Statins should be continued in patients already taking these agents prior to surgery. The optimal duration and time of initiation of statin therapy remains unclear.