(1)   A 45 years old man is undergoing an elective coronary artery bypass grafting for triple vessel disease. He is on atorvastatin 40 mg daily since the past 6 months. His preoperative LDL is 124 mg/dL. Which of the following statements is true? 

(a)    He needs to be started on Gemfibrozil in addition to optimize lipid control.

(b)   His Atorvastatin needs to be stopped one day before surgery.

(c)    Cholestyramine needs to be started to optimize control of lipids

(d)   Niacin needs to be added.

 Answer: The answer is (b). Statins have the propensity to cause myopathy and so as a precaution these agents have to be discontinued a day prior to surgery and then restarted when the patient can take oral food. There is no immediate indication to add on another agent right away. 

We know that those who do not re-start their statin or discontinue it for longer periods pre-op have greater adverse outcomes.