[Use of medicines to reduce the risk of postoperative cardiac death: too early for guidelines].

In a review in this journal, Feringa et al. focused on the prevention of cardiovascular complications after non-cardiac surgery. Beta-blockers and statins appear to be the most effective in reducing post-operative mortality due to cardiac events. We have doubts about the external validity of the studies on cardiovascular risks after non-cardiac surgery. A major limitation is that conclusions for all patients have been drawn from relatively small samples with a selection of high-risk patients. Guidelines based upon such studies are 'premature', possibly dangerous and unethical, since the acceptance of such guidelines would preclude large scale studies to confirm the conclusions of the small studies so far performed. Perioperative beta-blockade is only needed in a subgroup of patients with a high-risk cardiac profile.