[Lipid lowering therapy: new pathophysiologic aspects and clinical implications].
Lipid-lowering therapy reduces cardiovascular morbidity and mortality. Although atherosclerotic plaques regress under lipid-lowering therapy, only minor changes in arteriosclerotic plaques are angiographically detectable. These changes cannot fully explain all the benefits of lipid-lowering therapy. Additional factors independent of macroscopically detectable alterations in plaque size may contribute to the clinical effects of lipid-lowering therapy. Qualitative changes in the composition of atherosclerotic plaques may reduce the risk of subsequent plaque rupture. Furthermore, hypercholesterolemia is associated with endothelial dysfunction, i.e., impaired endothelium-mediated vasodilation, induction of adhesion molecules, and altered expression of growth factors. Lipid lowering seems to reverse endothelial dysfunction. Also, lipid-lowering therapy may reduce peripheral arterial resistance and hyperinsulinemia, and may improve erythrocyte deformability. These effects of lipid-lowering therapy may contribute to the clinical benefits. In particular, the concept of endothelial dysfunction as a first, reversible manifestation of target organ damage deserves further attention in the diagnosis and therapy of cardiovascular disease.
Nordmann
A
A
Medizinische Universitäts-Poliklinik, Kantonsspital Basel.
Martina
B
B
Keller
U
U
Battegay
E
E
D001161:Arteriosclerosis / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D004907:Erythrocyte Deformability / Q000187:drug effects / Q000502:physiology; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D000960:Hypolipidemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D016896:Treatment Outcome; D014655:Vascular Resistance / Q000187:drug effects / Q000502:physiology
D000960:Hypolipidemic Agents; D007328:Insulin
Lipidsenkung: neue pathophysiologische Aspekte und klinische Implikationen.