Mannacio et al Acquired Cardiovascular Disease A C

Myocardial damage (MD), as assessed based on biochem-ical marker increase, occurs very frequently after coronary surgery.1-4 Even if marker increase can be observed in more than 60 % of patients, electrocardiographic abnormal-ities, echocardiographic abnormalities, or both suggestive of myocardial infarction (MI)5,6 are detectable in only 1 % to 3 % of them. In most patients cardiac function re-mains unaltered, yet evidence of MD is a sensible predictor of early and late cardiovascular events.4,7-9 Many clinical and intraoperative factors concur with the pathogenesis of this condition, and recently, the contribution of an in-flammatory response has been demonstrated in the process leading to MD.10-13 Several clinical and experimental studies have suggested the usefulness of preoperative statin treatment in preventing MD after coronary artery bypass graft (CABG) surgery.14,15 3-hydroxy-3-methyl-glutaryl-CoA (HMG-CoA) reductase inhibitors have been shown to significantly reduce cardiovas-cular risk independently of their lipid-lowering effect16,17 and to exert both a vasoprotective and an anti-inflammatory effect.18 Rosuvastatin (RSV) is a new-generation statin with a highly effective lipid-lowering and antiatherosclerotic ac-tivity.19,20 Its pharmacologic action has been shown at lower doses and with less collateral effects compared with other commonly used statins; however, only few data are available about its advantageous anti-inflammatory properties.16,19 We performed a randomized placebo-controlled trial of RSV pretreatment (20 mg/d) before elective coronary artery bypass surgery, investigating the possible effect of a 7-day preoperative statin treatment on reducing postoperative re-lease of markers of MD