Statins are widely prescribed cholesterol lowering agents that exert their effects by inhibiting 3-hydroxy-3methylglutaryl co-enzyme A reductase. With their modulatory effects on the atherogenic lipid profile, the role of statin therapy is expanding amidst the growing obesity epidemic. The cholesterol lowering effects of statin therapy remains central in the long term management of coronary artery disease and cerebrovascular disease. While statin therapy is used commonly to target elevated LDL cholesterol, there is emerging evidence supporting its role during acute coronary syndromes and stroke. Clinical research into plaque histology, vulnerable high risk plaques and plaque rupture has improved our insight into the pathophysiology of these acute vascular events. Non lipid lowering effects of statin, the so called pleitrophic effects, have become the focal point of investigation. This review discusses recent experimental and clinical evidence supporting the role of statin in perioperative medicine.