Atorvastatin for high-risk statin-naïve patients undergoing noncardiac surgery: The Lowering the Risk of Operative Complications Using Atorvastatin Loading Dose (LOAD) randomized trial Journal Articles uri icon

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  • UNLABELLED: Preliminary evidence suggests that statins may prevent major perioperative vascular complications. METHODS: We randomized 648 statin-naïve patients who were scheduled for noncardiac surgery and were at risk for a major vascular complication. Patients were randomized to a loading dose of atorvastatin or placebo (80 mg anytime within 18hours before surgery), followed by a maintenance dose of 40 mg (or placebo), started at least 12hours after the surgery, and then 40 mg/d (or placebo) for 7days. The primary outcome was a composite of all-cause mortality, nonfatal myocardial injury after noncardiac surgery, and stroke at 30days. RESULTS: The primary outcome was observed in 54 (16.6%) of 326 patients in the atorvastatin group and 59 (18.7%) of 316 patients in the placebo group (hazard ratio [HR] 0.87, 95% CI 0.60-1.26, P=.46). No significant effect was observed on the 30-day secondary outcomes of all-cause mortality (4.3% vs 4.1%, respectively; HR 1.14, 95% CI 0.53-2.47, P=.74), nonfatal myocardial infarction (3.4% vs 4.4%, respectively; HR 0.76, 95% CI 0.35-1.68, P=.50), myocardial injury after noncardiac surgery (13.2% vs 16.5%; HR 0.79, 95% CI 0.53-1.19, P=.26), and stroke (0.9% vs 0%, P=.25). CONCLUSION: In contrast to the prior observational and trial data, the LOAD trial has neutral results and did not demonstrate a reduction in major cardiovascular complications after a short-term perioperative course of statin in statin-naïve patients undergoing noncardiac surgery. We demonstrated, however, that a large multicenter blinded perioperative statin trial for high-risk statin-naïve patients is feasible and should be done to definitely establish the efficacy and safety of statin in this patient population.


  • Berwanger, Otavio
  • de Barros e Silva, Pedro GM
  • Barbosa, Roberto Ramos
  • Precoma, Dalton Bertolim
  • Figueiredo, Estêvão Lanna
  • Hajjar, Ludhmila Abrahão
  • Kruel, Cleber Dario Pinto
  • Alboim, Carolina
  • Almeida, Adail Paixão
  • Dracoulakis, Marianna Deway Andrade
  • Filho, Hugo Vargas
  • Carmona, Maria José Carvalho
  • Maia, Lília Nigro
  • de Oliveira Filho, João Bosco
  • Saraiva, Jose Francisco Kerr
  • Soares, Rafael M
  • Damiani, Lucas
  • Paisani, Denise
  • Kodama, Alessandra A
  • Gonzales, Beatriz
  • Ikeoka, Dimas T
  • Devereaux, Philip
  • Lopes, Renato D

publication date

  • February 2017

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