***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Neutrophils play a central role in systemic inflammatory reaction after cardiopulmonary bypass . Apoptosis is significantly delayed , and this might exacerbate systemic and myocardial damage . We tested the hypothesis of whether pretreatment with simvastatin increases the apoptotic rate of neutrophils and hence reduces the entity of inflammatory reaction . METHODS Thirty patients undergoing coronary surgery with cardiopulmonary bypass were r and omized to treatment with either simvastatin ( 40 mg/day ) or placebo for 3 weeks before surgery . A group of 15 patients undergoing off-pump coronary surgery served as controls . Blood sample s for detection of serum cytokine levels were obtained before anesthesia , at the end of surgery , and at 4 , 24 , 48 , and 72 hours postoperatively . Apoptosis and indices of activation were assessed in cultured neutrophils . RESULTS Simvastatin significantly reduced the postoperative peak values of interleukin (IL)-6 and IL-8 . The neutrophil apoptotic rate was significantly higher among neutrophils obtained from patients pretreated with simvastatin ( p < 0.05 at both 8 and 24 hours ) compared with placebo . Neutrophils from the statin group had depressed functional activity , as underscored by significantly lower values of CD11b ( p < 0.01 at 24 hours ) and a significantly less percentage of cells positive for nitro-blue tetrazolium ( p < 0.01 at 12 and 24 hours ) compared with placebo . CONCLUSIONS This r and omized , double-blind study indicates that statin therapy before cardiopulmonary bypass is associated with reduction of circulating markers of inflammation and increased neutrophil apoptosis . These data support a routine inclusion of statins as an adjuvant pharmacologic therapy before cardiopulmonary bypass surgery BACKGROUND Studies have shown that treatment of hyperlipidemia , especially lowering of plasma LDL levels , retards the progression of coronary atherosclerosis and prevents clinical cardiovascular events . No such studies have focused on subjects with low levels of HDL cholesterol . METHODS AND RESULTS We r and omly assigned 395 post-coronary bypass men , who had an HDL cholesterol concentration < or = 1.1 mmol/L and LDL cholesterol < or = 4.5 mmol/L , to receive gemfibrozil 1200 mg/d or placebo . Coronary angiography was performed at baseline and after , on average , 32 months of therapy . Changes in coronary dimensions were assessed by computer-assisted analysis . Average on-trial serum triglyceride concentrations were 1.69+/-0.68 and 1.02+/-0.37 , total cholesterol 5.48+/-0.68 and 4.83+/-0.63 , LDL cholesterol 3.84+/-0.59 and 3.39+/-0.56 , and HDL cholesterol 0.88+/-0.15 and 0.98+/-0.17 mmol/L in the placebo and gemfibrozil groups , respectively ( mean+/-SD , each P<.001 ) . The change in per-patient means of average diameters of native coronary segments was -0.04+/-0.11 mm in the placebo group and -0.01+/-0.10 mm in the gemfibrozil group ( P=.009 ) . The equivalent changes in minimum luminal diameters of stenoses were -0.09+/-0.18 and -0.04+/-0.15 mm , respectively ( P=.002 ) . A similar , albeit nonsignificant , trend toward treatment benefit was found in the predefined primary study end point , segments unaffected by grafts and those distal to graft insertions . In aortocoronary bypass grafts , 23 subjects ( 14 % ) assigned to placebo had new lesions in the follow-up angiogram , compared with 4 subjects ( 2 % ) assigned to gemfibrozil ( P<.001 ) . CONCLUSIONS Gemfibrozil therapy retarded the progression of coronary atherosclerosis and the formation of bypass-graft lesions after coronary bypass surgery in men with low HDL cholesterol as their main lipid abnormality OBJECTIVE Statin therapy in ambulatory population s is associated with a significant reduction in adverse cardiovascular events , including death and myocardial infa rct ion . Much less is known about the beneficial effects of statins on acute perioperative cardiovascular events . The purpose of this study was to determine whether preoperative statin therapy is associated with a reduced risk of early cardiac death or nonfatal , in-hospital postoperative myocardial infa rct ion after primary , elective coronary artery bypass graft surgery requiring cardiopulmonary bypass . METHODS The Multicenter Study of Perioperative Ischemia ( McSPI ) Epidemiology II Study was a prospect i ve , longitudinal study of 5436 patients undergoing coronary artery bypass graft surgery between November 1996 and June 2000 at 70 centers in 17 countries . The present study consisted of a pre-specified subset of these subjects divided into patients receiving ( n = 1352 ) and not receiving ( n = 1314 ) preoperative statin therapy . To control for potential bias related to use of statin therapy , the study estimated propensity scores by logistic regression to determine the predicted probability of inclusion in the " statin " group . Multivariate , stepwise logistic regression was then performed , controlling for patient demographics , medical history , operative characteristics , and propensity score to determine whether preoperative statin therapy was independently associated with a reduction in the risk of early ( DOS-POD3 ) cardiac death and /or nonfatal , in-hospital postoperative myocardial infa rct ion . RESULTS Preoperative statin therapy was independently associated with a significant reduction ( adjusted odds ratio [ OR ] 0.25 ; 95 % confidence intervals [ CI ] 0.07 - 0.87 ) in the risk of early cardiac death after primary , elective coronary bypass surgery ( 0.3 % vs 1.4 % ; P < .03 ) , but was not associated with a reduced risk of postoperative nonfatal , in-hospital myocardial infa rct ion ( 7.9 % vs 6.2 % ; P = not significant ) . Discontinuation of statin therapy after surgery was independently associated with a significant increase in late ( POD4-discharge ) all-cause mortality ( adjusted OR 2.64 ; 95 % CI 1.32 - 5.26 ) compared with continuation of statin therapy ( 2.64 % vs 0.60 % ; P < .01 ) . This was true even when controlling for the postoperative discontinuation of aspirin , beta-blocker , or angiotensin-converting enzyme inhibitor therapy . Discontinuation of statin therapy after surgery was also independently associated with a significant increase in late cardiac mortality ( adjusted OR 2.95 ; 95 % CI 1.31 - 6.66 ) compared with continuation of statin therapy ( 1.91 % vs 0.45 % ; P < 0.01 ) . CONCLUSIONS Preoperative statin use is associated with reduced cardiac mortality  after primary , elective coronary artery bypass grafting . Postoperative statin discontinuation is associated with increased in-hospital mortality . Although further r and omized trials are needed to confirm these findings , these data suggest the importance of perioperative statin administration OBJECTIVE To test the hypothesis that perioperative statin use reduces  acute kidney injury ( AKI ) after cardiac surgery . DESIGN A retrospective analysis of prospect ively collected data from an ongoing clinical trial . SETTING A quaternary-care university hospital . PARTICIPANTS Three hundred twenty-four adult elective cardiac surgery patients . INTERVENTIONS None . MEASUREMENTS AND MAIN RESULTS The authors assessed the association of preoperative statin use , early postoperative statin use , and acute statin withdrawal with the incidence of AKI . Early postoperative statin use was defined as statin treatment within the first postoperative day . Statin withdrawal was defined as the discontinuation of preoperative statin treatment before surgery until at least postoperative day 2 . Logistic regression and propensity score modeling were used to control for AKI risk factors . Sixty-eight of 324 patients ( 21.0 % ) developed AKI . AKI patients stayed in the hospital longer ( p = 0.03 ) and were more likely to develop pneumonia ( p = 0.002 ) or die ( p = 0.001 ) . A higher body mass index ( p = 0.003 ) , higher central venous pressure ( p = 0.03 ) , and statin withdrawal ( 27.4 v 14.7 % , p = 0.046 ) were associated with a higher incidence of AKI , whereas early postoperative statin use was protective ( 12.5 % v 23.8 % , p = 0.03 ) . Preoperative statin use did not affect the risk of AKI . In multivariate logistic regression , age ( p = 0.03 ) , male sex ( p = 0.02 ) , body mass index ( p < 0.001 ) , and early postoperative statin use ( odds ratio = 0.32 ; 95 % confidence interval , 0.14 - 0.72 ; p = 0.006 ) independently predicted AKI . Propensity score-adjusted risk assessment confirmed the association between early postoperative statin use and reduced AKI ( odds ratio = 0.30 ; 95 % confidence interval , 0.13 - 0.70 ; p = 0.005 ) . CONCLUSIONS Early postoperative statin use is associated with a lower incidence of AKI among both chronic statin users and statin-naive cardiac surgery patients Background — Atrial fibrillation ( AF ) after cardiac surgery is associated with increased risk of complications , length of stay , and cost of care . Observational evidence suggests that patients who have undergone previous statin therapy have a lower incidence of postoperative AF . We tested this observation in a r and omized , controlled trial . Methods and Results — Two hundred patients undergoing elective cardiac surgery with cardiopulmonary bypass , without previous statin treatment or history of AF , were enrolled . Patients were r and omized to atorvastatin ( 40 mg/d , n=101 ) or placebo  ( n=99 ) starting 7 days before operation . The primary end point was incidence of postoperative AF ; secondary end points were length of stay , 30-day major adverse cardiac and cerebrovascular events , and postoperative C-reactive protein ( CRP ) variations . Atorvastatin significantly reduced the incidence of AF versus placebo ( 35 % versus 57 % , P=0.003 ) . Accordingly , length of stay was longer in the placebo versus atorvastatin arm ( 6.9±1.4 versus 6.3±1.2 days , P=0.001 ) . Peak CRP levels were lower in patients without AF ( P=0.01 ) , irrespective of r and omization assignment . Multivariable analysis showed that atorvastatin treatment conferred a 61 % reduction in risk of AF ( odds ratio 0.39 , 95 % confidence interval 0.18 to 0.85 , P=0.017 ) , whereas high postoperative CRP levels were associated with increased risk ( odds ratio 2.0 , 95 % confidence interval 1.2 to 7.0 , P=0.01 ) . The incidence of major adverse cardiac and cerebrovascular events at 30 days was similar in the 2 arms . Conclusions — Treatment with atorvastatin 40 mg/d , initiated 7 days before surgery , significantly reduces the incidence of postoperative AF after elective cardiac surgery with cardiopulmonary bypass and shortens hospital stay . These results may influence practice patterns with regard to adjuvant pharmacological therapy before cardiac surgery OBJECTIVE It has earlier been suggested that postoperative thrombocytosis frequently occur after coronary artery  bypass grafting ( CABG ) and may be linked to lipid disturbances . A prospect i ve r and omized study was undertaken to evaluate if preoperative lipid-control , using HMG-CoA-reductase inhibitor ( Zocor ) , simvastatin , reduces the risk of postoperative thrombocytosis . METHODS Seventy-seven patients with symptomatic coronary artery disease and hypercholesterolemia ( total cholesterol > or = 6.2 mmol/l ) , planned for CABG where r and omly assigned to ; undergo CABG without preoperation lipid control ( group I , n = 37 ) or undergo simvastatin-treatment ( 20 mg daily ) to control their lipids ( 4 weeks ) prior to CABG ( group II , n = 40 ) . RESULTS Patient characteristics and operation data did not differ between the groups . Serum-cholesterol , cholesterol/HDL-cholesterol , LDL-cholesterol , Apolipoprotein A1 and Plasminogen were all significantly higher in group I patients compared with group II just prior to surgery . Other laboratory parameters did not differ . RESULTS In group II , total cholesterol and cholesterol/HDL-cholesterol quota were significantly lowered by simvaststin ( -2 and -29 % , respectively ) . Postoperative throm 
    Output:
    
RECENT FINDINGS When administered prior to CABG , statins reduce the risk of perioperative mortality , stroke , and atrial fibrillation .
After CABG , statins limit the progression of atherosclerosis in native coronary arteries , inhibit the process of saphenous vein graft disease , and improve vein graft patency .
Furthermore , postoperative statins reduce the recurrence of cardiovascular events and improve all-cause mortality .
SUMMARY Statins clearly improve the outcomes of CABG patients .