Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 20 4 2025 12 06 276 284 Mohammad Aminizadeh rajaie cardiovascular medical and research center, school of medicine, iran university of medical sciences, tehran, iran Seyyed Hosein Mousavi Trauma and Surgery Research Center, Aja University of Medical Sciences, Tehran, Iran Reza Mosaed Department of Clinical Pharmacy, School of Medicine, AJA University of Medical Sciences, Tehran, Iran Mehran Khoshfetrat Trauma and Surgery Research Center, Aja University of Medical Sciences, Tehran, Iran Reza Arefizdeh Trauma and Surgery Research Center, Aja University of Medical Sciences, Tehran, Iran Mohsen Askari Department of Internal Medicine, School of Medicine, Aja University of Medical Sciences, Tehran, Iran Seyed Abolfazl Mohsenizade Trauma and Surgery Research Center, Aja University of Medical Sciences, Tehran, Iran 2025 09 20 2025 10 26 Background: Cardiovascular complications account for a substantial proportion of perioperative complications. This study aimed to evaluate whether preoperative high-dose atorvastatin reduces postoperative changes in serum high-sensitivity cardiac troponin (hs-cTn) concentrations in patients at elevated cardiac risk undergoing noncardiac surgery. Methods: In this triple-blind, parallel-group, randomized controlled trial, adults with a Revised Cardiac Risk Index (RCRI) of 1 or greater scheduled for noncardiac surgery were randomized (1:1) to receive atorvastatin 80 mg 24 hours preoperatively or placebo. The primary outcome was the change in serum hs-cTn concentrations 24 hours after surgery. Secondary outcomes included the incidence of major adverse cardiovascular events (MACE) within 7 days after surgery, as well as cardiovascular death, myocardial infarction, stroke, heart failure, arrhythmia, or transient ischemic attack. Results: A total of 112 patients with similar baseline characteristics were randomized and completed a 7-day follow-up. Postoperative hs-cTn levels increased significantly in the placebo group (P<0.001) but decreased in the statin group (P<0.001), with a significant between-group difference favoring statin therapy (P<0.001). Subgroup analyses by anesthesia type and prior statin use showed consistent findings. MACE occurred in three patients (5.4%) in the statin group and two patients (3.6%) in the placebo group (P=1.00). Conclusion: Preoperative high-dose atorvastatin significantly reduced postoperative hs-cTn levels, indicating a biochemical cardioprotective effect, but it did not translate into a reduction of short-term clinical cardiovascular events. Larger multicenter trials with longer follow-up are required to determine whether troponin reduction translates into improved clinical outcomes. https://jthc.tums.ac.ir/index.php/jthc/article/view/2351 https://jthc.tums.ac.ir/index.php/jthc/article/download/2351/1232