Effects of perioperative statin use on cardiovascular complications in patients submitted to non-cardiac surgery: protocol for a systematic review, meta-analysis, and trial sequential analysis

Systematic Reviews. 2017;6(1):1-8 DOI 10.1186/s13643-017-0500-0


Journal Homepage

Journal Title: Systematic Reviews

ISSN: 2046-4053 (Online)

Publisher: BMC

LCC Subject Category: Medicine

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML



Erica Aranha Suzumura (Research Institute, Hospital do Coração (HCor))

Rodrigo Antonini Ribeiro (Graduate Program in Epidemiology, Federal University of Rio Grande do Sul)

Leticia Kawano-Dourado (Research Institute, Hospital do Coração (HCor))

Pedro Gabriel de Barros e Silva (Research Institute, Hospital do Coração (HCor))

Claudia Oliveira (Research Institute, Hospital do Coração (HCor))

Mabel Fernandes Figueiró (Research Institute, Hospital do Coração (HCor))

Alexandre Biasi Cavalcanti (Research Institute, Hospital do Coração (HCor))

Renato D. Lopes (Research Institute, Hospital do Coração (HCor))

Otavio Berwanger (Research Institute, Hospital do Coração (HCor))


Open peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 11 weeks


Abstract | Full Text

Abstract Background Preliminary evidence suggests statins may reduce major perioperative vascular events. However, evidence is limited to observational studies, underpowered trials, and non-comprehensive systematic reviews. This review aims to assess the effects of perioperative statin use on cardiovascular complications in patients submitted to non-cardiac surgery. Methods We will search MEDLINE/PubMed, EMBASE, LILACS, CENTRAL, Web of Science, and CINAHL for randomized controlled trials assessing the effects of perioperative statin use in adults undergoing non-cardiac surgery and reporting cardiovascular complications. For patients already using statins for hyperlipidemia, a preoperative loading dose of statin is required in the experimental group. We will place no language or publication restriction on our search. Teams of two reviewers will independently assess eligibility and risk of bias, and will extract data from the included trials. Our primary outcome is a combination of cardiovascular mortality or non-fatal myocardial infarction. We will also assess the following outcomes: individual components of the primary outcome, all-cause mortality, total myocardial infarction, elevated troponin in the first seven postoperative days, total stroke, total venous thromboembolism, postoperative atrial fibrillation, elevation of creatine phosphokinase or liver enzymes, and rates of myalgia or rhabdomyolysis. We will conduct meta-analyses using random-effects model and will use trial sequential analysis to establish monitoring boundaries to limit global type I error due to repetitive testing for our primary outcome. We will rate the quality of evidence using the GRADE system. Discussion The results of this systematic review may help to inform clinical practice and also the design of future large-scale randomized trials. Systematic review registration PROSPERO CRD42016035987