ANTIATHEROTHROMBOTIC PROPERTIES OF STATINS - IMPLICATIONS FOR CARDIOVASCULAR EVENT REDUCTION

Clinical trials of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) red uctase inhibitors or statin therapy have demonstrated that baseline or treated low-density lipoprotein (LDL) cholesterol levels are only wea kly associated with net coronary angiographic change or cardiovascular events. The beneficial effects of statins on clinical events may invo lve nonlipid mechanisms that modify endothelial function, inflammatory responses, plaque stability, and thrombus formation. Experimental ani mal models suggest that statins may foster stability through a reducti on in macrophages and cholesterol ester content and an increase in vol ume of collagen and smooth muscle cells. The thrombotic sequelae cause d by plaque disruption is mitigated by statins through inhibition of p latelet aggregation and maintenance of a favorable balance between pro thrombotic and fibrinolytic mechanisms. These nonlipid properties of s tatins may help to explain the early and significant cardiovascular ev ent reduction reported in several clinical trials of statin therapy.