Effects of statins on vascular structure and function: a systematic review.
OBJECTIVE
Statins reduce cardiovascular events by more than can be explained by their effects on lipids. We conducted a systematic review of how statins affect vascular structure and function, differences among statins, and correlations between the effects of statins on vascular outcomes and either lipid levels or cardiovascular outcomes.


METHODS
We primarily searched MEDLINE (1980 to March 2004) to identify all studies with at least 10 subjects that reported the effects of currently available statins on coronary artery stenosis, carotid intima-media thickness, and endothelial function (excluding studies of drug combinations and subjects with organ transplants). Meta-analyses were performed when feasible.


RESULTS
Statins decrease the progression and increase the regression of coronary artery lesions and luminal narrowing. Compared with placebo, statins decrease the likelihood of coronary artery restenosis (summary risk ratio = 0.85; 95% confidence interval: 0.77 to 0.95). Statins appear to slow the progression of carotid artery intima-media thickness. Although the effect of statins on coronary endothelial function is uncertain, statins appear to improve peripheral endothelial function. There is no conclusive evidence to suggest that individual statins differ in their effects on these outcomes. Studies generally found weak or no correlation between the effects of statins on vascular outcomes and lipid levels. No study showed a correlation between vascular effect and clinical outcome.


CONCLUSIONS
Statins slow the progression of, and may reverse, atherosclerosis. The magnitude of these effects, however, is small compared with the effects of statins on cardiovascular events. Statins also improve measures of vascular function, which may contribute to their clinical benefits. There is insufficient evidence to suggest that individual statins differ in their vascular effects.
Balk
Ethan M
EM
Center for Clinical Evidence Synthesis, Institute for Clinical Research and Health Policy Studies.
Karas
Richard H
RH
Jordan
Harmon S
HS
Kupelnick
Bruce
B
Chew
Priscilla
P
Lau
Joseph
J
D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy*; D017023:Coronary Angiography; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000187:drug effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology*; D008055:Lipids / Q000097:blood; D017539:Tunica Intima / Q000187:drug effects; D017540:Tunica Media / Q000187:drug effects
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids