Beneficial effects of statins in coronary artery disease - Beyond loweringcholesterol

OBJECTIVES: To review the benefits of statins in coronary artery disease ma nagement beyond their cholesterol-lowering effects. DATA SOURCES: A MEDLINE search (1966-May 2000) was conducted using the foll owing terms: lovastatin, pravastatin, simvastatin, atorvastatin, fluvastati n, cerivastatin, endothelium, plaque stabilization, antithrombotic effects. STUDY SELECTION: English-language human studies and case reports. DATA EXTRACTION: Studies published demonstrating other mechanisms of statin s' clinical beneficial effects were evaluated and reviewed. DATA SYNTHESIS: The understanding of the pharmacologic effects of stains ha s led to the realization that the benefits of these agents extend beyond si mply lowering cholesterol. These properties include beneficial effects on v essel endothelial tissue; decreased low-density lipoprotein oxidation and i nflammation; ability to stabilize atherosclerotic plaques and perhaps promo te regression; proliferative effects on smooth-muscle growths, possibly str engthening atherosclerotic plaques; antithrombotic effects by inhibiting pl atelet aggregation and stimulation of fibrinolytic factors; and improvement of blood viscosity and flow. With these actions, statins may benefit the s ituation of long-term atherosclerotic plaque formation and the setting of a cute coronary syndrome. CONCLUSIONS: Further large-scale studies are needed to determine the clinic al importance and validity of these postulated beneficial effects of statin s.