Potential nontraditional applications of statins.
OBJECTIVE
To review the current evidence for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) in nontraditional lipid-related applications, including acute coronary syndromes, peripheral arterial disease, stroke, and renal disease, and to describe ongoing trials evaluating the role of statins in these conditions.


METHODS
Clinical literature was identified by a MEDLINE search (1990-November 2002) using >/=1 of the following search terms: acute coronary syndrome(s), angina pectoris, atherosclerosis, atorvastatin, clinical trials, diabetes mellitus, end-stage renal disease, fluvastatin, lovastatin, myocardial infarction, peripheral arterial disease, pravastatin, simvastatin, statins, and stroke. Treatment guidelines issued by professional and governmental organizations, such as the American Diabetes Association, American Heart Association, National Cholesterol Education Program, National Kidney Foundation, and National Stroke Foundation, were reviewed.


METHODS
Articles identified from the data sources were included if they pertained to the conditions described in the objectives and provided unique information concerning use of statins.


RESULTS
Substantial evidence exists for the use of statins in acute coronary syndromes. Meta-analyses of data from major clinical trials indicate that statins prevent first and recurrent stroke, and large-scale trials are underway to evaluate the efficacy of statins in this setting. Accumulating evidence suggests that statins may be beneficial in reducing the morbidity and mortality associated with peripheral arterial disease and end-stage renal disease, and results from ongoing trials may confirm these benefits. Statins may also have a future role in amelioration of other conditions associated with atherosclerosis, such as diabetes mellitus.


CONCLUSIONS
A large body of evidence supports the evaluation of statins in clinical settings beyond primary and secondary prevention of morbidity and mortality associated with coronary atherosclerosis.
McKenney
James M
JM
School of Pharmacy, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA, USA. jmckenney@ncrinc.net
D001157:Arterial Occlusive Diseases / Q000188:drug therapy*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007674:Kidney Diseases / Q000188:drug therapy*; D020521:Stroke / Q000188:drug therapy*
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors