{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T18:32:59Z","timestamp":1793125979538,"version":"4.5.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Swedish government"},{"DOI":"10.13039\/501100001034","name":"ALF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001034","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Statins\u2019 anti-inflammatory and endothelial-stabilizing effects suggest perioperative value, but trials of de novo initiation were discredited following research misconduct. Whether established preoperative statin therapy lowers postoperative mortality dose dependently remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We studied 56 362 patients aged \u226545 years undergoing non-cardiac surgery at two university hospitals (2016\u201323). Preoperative statin exposure was assessed as status (any vs. none), intensity (high vs. low\/intermediate), and regimen (high vs. low\/intermediate vs. none). Primary outcomes were 30- and 365-day mortality. Inverse probability of treatment weighting, using random forest\u2013estimated propensity scores targeting the average treatment effect in the treated, was applied to balance measured confounders. Associations were estimated with weighted Cox regression. Overall, 372 patients (0.6%) died within 30 days and 3735 (6.6%) within 365 days. After weighting, all covariates were balanced. Statin therapy showed a directionally consistent but non-significant association with lower 30-day mortality [hazard ratio (HR), 0.78; 95% CI, 0.57\u20131.07] and was associated with lower 365-day mortality [HR, 0.81; 95% CI, 0.73\u20130.90; absolute risk difference (ARD), \u22121.2 percentage points; number needed to treat, 83]. A dose\u2013response relationship was evident: vs. no statin, high-intensity therapy showed a 29% lower hazard (HR, 0.71; 95% CI, 0.60\u20130.83; ARD, \u22122.3 points) and low-\/intermediate-intensity therapy a 16% lower hazard (HR, 0.84; 95% CI, 0.74\u20130.96). Findings were consistent across sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among adults undergoing non-cardiac surgery, established preoperative statin therapy was associated with dose-dependent lower 365-day mortality. These findings suggest perioperative statin continuation as a preventive strategy and warrant confirmation in a randomized trial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag532","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:52:04Z","timestamp":1791546724000},"source":"Crossref","is-referenced-by-count":1,"title":["The impact of statin therapy on postoperative short- and long-term mortality and morbidity after non-cardiac surgery: a prospective dual-centre observational study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7464-0324","authenticated-orcid":false,"given":"Max","family":"Bell","sequence":"first","affiliation":[{"name":"Function Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital , Eugeniav\u00e4gen 3, Stockholm 17176 ,","place":["Sweden"]},{"name":"Department of Physiology and Pharmacology, Karolinska Institutet , Solnav\u00e4gen 9, Stockholm 17165 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6015-2405","authenticated-orcid":false,"given":"Albert","family":"Bremberg","sequence":"additional","affiliation":[{"name":"Department of Physiology and Pharmacology, Karolinska Institutet , Solnav\u00e4gen 9, Stockholm 17165 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Mellbin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Solna, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"Heart, Vascular and Neuro Theme, Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-5781","authenticated-orcid":false,"given":"Arman","family":"Valadkhani","sequence":"additional","affiliation":[{"name":"Function Perioperative Medicine and Intensive Care (PMI), Karolinska University Hospital , Eugeniav\u00e4gen 3, Stockholm 17176 ,","place":["Sweden"]},{"name":"Department of Physiology and Pharmacology, Karolinska Institutet , Solnav\u00e4gen 9, Stockholm 17165 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"2026102713415344600_zwag532-B1","doi-asserted-by":"crossref","first-page":"214","DOI":"10.3390\/pharmaceutics16020214","article-title":"Potential benefits and risks associated with the use of statins","volume":"16","author":"Khatiwada","year":"2024","journal-title":"Pharmaceutics"},{"key":"2026102713415344600_zwag532-B2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3390\/ph15020151","article-title":"Beyond lipid-lowering: effects of statins on cardiovascular and cerebrovascular diseases and cancer","volume":"15","author":"Morofuji","year":"2022","journal-title":"Pharmaceuticals (Basel)"},{"key":"2026102713415344600_zwag532-B3","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1213\/ANE.0000000000005175","article-title":"Systemic inflammatory response syndrome after surgery: mechanisms and protection","volume":"131","author":"Margraf","year":"2020","journal-title":"Anesth Analg"},{"key":"2026102713415344600_zwag532-B4","doi-asserted-by":"publisher","first-page":"967","DOI":"10.1016\/j.jvs.2004.01.004","article-title":"Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial","volume":"39","author":"Durazzo","year":"2004","journal-title":"J Vasc Surg"},{"key":"2026102713415344600_zwag532-B5","doi-asserted-by":"crossref","first-page":"980","DOI":"10.1056\/NEJMoa0808207","article-title":"Fluvastatin and perioperative events in patients undergoing vascular surgery","volume":"361","author":"Schouten","year":"2009","journal-title":"N Engl J Med"},{"key":"2026102713415344600_zwag532-B6","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1097\/SLA.0b013e3181a77d00","article-title":"Bisoprolol and fluvastatin for the reduction of perioperative cardiac mortality and myocardial infarction in intermediate-risk patients undergoing noncardiovascular surgery: a randomized controlled trial (DECREASE-IV)","volume":"249","author":"Dunkelgrun","year":"2009","journal-title":"Ann Surg"},{"key":"2026102713415344600_zwag532-B7","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/eurheartj\/ehv456","article-title":"Association between pre-operative statin use and major cardiovascular complications among patients undergoing non-cardiac surgery: the VISION study","volume":"37","author":"Berwanger","year":"2016","journal-title":"Eur Heart J"},{"key":"2026102713415344600_zwag532-B8","doi-asserted-by":"crossref","first-page":"2092","DOI":"10.1001\/jama.291.17.2092","article-title":"Lipid-lowering therapy and in-hospital mortality following major noncardiac surgery","volume":"291","author":"Lindenauer","year":"2004","journal-title":"JAMA"},{"key":"2026102713415344600_zwag532-B9","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1001\/jamainternmed.2016.8005","article-title":"Association of perioperative statin use with mortality and morbidity after major noncardiac surgery","volume":"177","author":"London","year":"2017","journal-title":"JAMA Intern Med"},{"key":"2026102713415344600_zwag532-B10","doi-asserted-by":"crossref","first-page":"e285","DOI":"10.1016\/j.jacc.2018.11.003","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines","volume":"73","author":"Grundy","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2026102713415344600_zwag532-B11","doi-asserted-by":"crossref","first-page":"3826","DOI":"10.1093\/eurheartj\/ehac270","article-title":"2022 ESC guidelines on cardiovascular assessment and management of patients undergoing non-cardiac surgery","volume":"43","author":"Halvorsen","year":"2022","journal-title":"Eur Heart J"},{"key":"2026102713415344600_zwag532-B12","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.eclinm.2019.04.011","article-title":"Days at home after surgery: an integrated and efficient outcome measure for clinical trials and quality assurance","volume":"11","author":"Bell","year":"2019","journal-title":"EClinicalMedicine"},{"key":"2026102713415344600_zwag532-B13","doi-asserted-by":"crossref","first-page":"311","DOI":"10.5694\/mja2.51658","article-title":"Hospital costs and factors associated with days alive and at home after surgery (DAH(30))","volume":"217","author":"Reilly","year":"2022","journal-title":"Med J Aust"},{"key":"2026102713415344600_zwag532-B14","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1001\/jamainternmed.2020.6084","article-title":"Evaluation of time to benefit of statins for the primary prevention of cardiovascular events in adults aged 50 to 75 years: a meta-analysis","volume":"181","author":"Yourman","year":"2021","journal-title":"JAMA Intern Med"},{"key":"2026102713415344600_zwag532-B15","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ahj.2016.11.001","article-title":"Atorvastatin for high-risk statin-naive patients undergoing noncardiac surgery: the lowering the risk of operative complications using atorvastatin loading dose (LOAD) randomized trial","volume":"184","author":"Berwanger","year":"2017","journal-title":"Am Heart J"},{"key":"2026102713415344600_zwag532-B16","doi-asserted-by":"crossref","first-page":"1635","DOI":"10.1001\/archinternmed.2009.324","article-title":"The healthy adherer effect","volume":"169","author":"Andersohn","year":"2009","journal-title":"Arch Intern Med"},{"key":"2026102713415344600_zwag532-B17","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1111\/jep.12095","article-title":"Healthy adherer effect - the pitfall in the interpretation of the effect of medication adherence on health outcomes","volume":"20","author":"Ladova","year":"2014","journal-title":"J Eval Clin Pract"},{"key":"2026102713415344600_zwag532-B18","doi-asserted-by":"crossref","first-page":"8732360","DOI":"10.1155\/2022\/8732360","article-title":"Effect of statins on Serum level of hs-CRP and CRP in patients with cardiovascular diseases: a systematic review and meta-analysis of randomized controlled trials","volume":"2022","author":"Kandelouei","year":"2022","journal-title":"Mediators Inflamm"},{"key":"2026102713415344600_zwag532-B19","doi-asserted-by":"crossref","first-page":"2439","DOI":"10.1093\/eurheartj\/ehab309","article-title":"SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe","volume":"42","author":"Score2workinggroup","year":"2021","journal-title":"Eur Heart J"}],"container-title":["European Journal of Preventive Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwag532\/71874174\/zwag532.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article-pdf\/doi\/10.1093\/eurjpc\/zwag532\/71874174\/zwag532.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:42:04Z","timestamp":1793122924000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjpc\/advance-article\/doi\/10.1093\/eurjpc\/zwag532\/8910594"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":19,"URL":"https:\/\/doi.org\/10.1093\/eurjpc\/zwag532","relation":{},"ISSN":["2047-4873","2047-4881"],"issn-type":[{"value":"2047-4873","type":"print"},{"value":"2047-4881","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"article-number":"zwag532"}}