Statins: Effective antiatherosclerotic therapy

Background Statins are the most effective agents currently available for lo wering plasma levels of low-density lipoprotein cholesterol (LDL-C) and are the mainstay of therapy for hyperlipidemia. The statins are highly liver-s elective, inhibiting 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reduct ase, a key enzyme in the synthesis of cholesterol. Several large, controlle d clinical trials have confirmed significant reductions in rates of coronar y heart disease morbidity and death with long-term statin therapy in patien ts with mild to severe hypercholesterolemia. Methods and Results This review article is based on a literature search of more than 60 relevant articles from peer-reviewed journals. Search engines included Medline and Embase. In surveying clinical and angiographic evidenc e, we found that statins appear to reduce the incidence of coronary events by slowing the progression of atherosclerosis and preventing atheromatous l esion formation. We found that the 6 statins currently marketed-atorvastati n, cerivastatin, fluvastatin, lovastatin, pravastatin, and simvastatin-diff er in their inhibitory action on the HMG-CoA reductase enzyme. Conclusions The use of more potent statins such as atorvastatin and simvast atin affords greater lowering of LDL-C and triglyceride levels, allowing mo re patients to achieve target goals. The question of how low LDL-C levels s hould be lowered will be answered by ongoing clinical trials.