Statins and other drugs that make a difference

The aetiology of perioperative cardiac morbidity and mortality is multifactorial. With the many and diverse aetiological factors involved, it is highly unlikely that one single intervention will successfully improve cardiac outcome following noncardiac surgery. Based on increasing knowledge of the nature of atherosclerotic coronary artery disease, and in view of the poor positive predictive value of the non-invasive cardiac stress tests and the considerable risk of coronary angiography and coronary revascularisation in high-risk patients, the paradigm is shifting from an emphasis on extensive non-invasive preoperative risk stratification to an emphasis on a combination of selective non-invasive testing and aggressive pharmacological perioperative therapy. Perioperative plaque stabilisation by pharmacological means may well be one of the most important cardioprotective interventions.