BACKGROUND: Aside from their cholesterol-lowering effects statins are known to 
have a range of other 'pleiotropic' effects. We present an overview of the basic 
science behind these effects and then review clinical trials and the current 
role of statins relevant to modern surgical practice.
METHODS: A systematic review of the literature was performed using the keywords 
surgery and the MeSH term for statins. All clinical studies relating to statin 
use in surgical patients were evaluated. An overview of the literature on statin 
use and cardiac outcomes was performed.
CONCLUSIONS: Statins are safe and have a wide range of pleiotropic effects 
relevant to surgical practice. Strongest evidence for their clinical use comes 
in primary cardiac risk reduction in many types of vascular surgery. There is a 
large body of evidence showing their benefit perioperatively in high-risk 
vascular and cardiac surgery but the picture is less clear for low-risk 
patients. Further studies are needed to evaluate exact dosage regimes and timing 
of administration. Novel uses of their anti-inflammatory properties in sepsis 
and vasomotor properties in subarachnoid haemorrhage are being further 
investigated by randomised trials.