Rosuvastatin Should NOT Be Stopped Preoperatively
Rosuvastatin and other statins should be continued throughout the perioperative period in patients already taking them chronically. Multiple high-quality guidelines uniformly recommend continuation of statin therapy perioperatively, with strong evidence showing that discontinuation increases cardiovascular complications and mortality.
Guideline Recommendations
The evidence is remarkably consistent across major guidelines:
2014 ACC/AHA Perioperative Guidelines provide a Class I, Level B recommendation to continue statins in patients currently taking them 1, 2. This is the strongest level of recommendation, indicating clear benefit.
2017 Canadian Cardiovascular Society Guidelines give an even stronger Strong Recommendation with Moderate-Quality Evidence to continue statin therapy perioperatively in patients receiving chronic statin therapy 3.
2024 AHA/ACC Perioperative Guidelines reaffirm this approach, emphasizing continuation of chronic medications including statins 4.
Why Continuation Is Critical
Statin withdrawal creates a dangerous "rebound effect" that significantly worsens outcomes:
- Discontinuing statins during acute vascular stress (like surgery) triggers deterioration of vascular function 5
- Studies show stopping statins during hospitalization for acute coronary syndrome leads to worse outcomes 5
- In stroke patients, stopping statins for just 3 days increased risk of death or dependency by 4.7-fold 5
- Perioperative statin discontinuation after major vascular surgery increases myocardial ischemia, nonfatal MI, and cardiovascular death 5
A specific study on rosuvastatin demonstrated protective effects: In 550 emergency surgery patients with stable coronary artery disease on chronic statins, those receiving preoperative rosuvastatin 20mg had significantly lower rates of myocardial infarction (3.6% vs 8.0%, p=0.03) and reduced major adverse cardiovascular events 3, 6.
Practical Implementation
Continue rosuvastatin through the day of surgery:
- Patients should take their usual dose on the morning of surgery
- Resume as soon as oral intake is feasible postoperatively
- Rosuvastatin's long half-life makes it particularly suitable for bridging periods when oral intake is temporarily interrupted 7
The only exception per FDA labeling is temporary discontinuation in patients experiencing acute conditions at high risk for rhabdomyolysis (sepsis, shock, severe hypovolemia, major trauma, severe metabolic/endocrine/electrolyte disorders, or uncontrolled epilepsy) 8. Note this refers to acute critical illness complications, not routine surgery itself.
Common Pitfalls to Avoid
Do not confuse statins with other perioperative medications:
- Unlike ACE inhibitors/ARBs (which may be held to prevent hypotension) 9
- Unlike antiplatelet agents (which require specific timing considerations) 1, 2
- Statins have a fundamentally different risk-benefit profile perioperatively
Do not stop statins due to theoretical myopathy concerns:
- Despite concerns about perioperative rhabdomyolysis risk, no studies support routine discontinuation 7
- A retrospective study of 981 vascular surgery patients found no cases of rhabdomyolysis or increased myopathy in statin users 7
- The risk of cardiovascular complications from stopping statins far exceeds any theoretical muscle toxicity risk
Recognize that discontinuation itself causes harm:
- Patients who had statins discontinued after CABG showed higher mortality than those continued on therapy 10, 11
- The 2011 ACCF/AHA CABG Guidelines specifically state discontinuation of statin therapy is Class III: Harm 11
Bottom Line
The evidence is unequivocal: continue rosuvastatin perioperatively. The cardiovascular protection provided by maintaining statin therapy during the stress of surgery substantially outweighs any theoretical risks, and discontinuation actively increases morbidity and mortality.