Pleiotropic effects of statins: stabilization of the vulnerable atherosclerotic plaque?
Acute coronary syndromes (ACS), i.e. unstable angina and myocardial infarction, are the leading causes of death in developed countries and developing countries alike. Lipid lowering intervention studies have demonstrated a 30% risk reduction in recurrent cardiovascular events and death, despite only modest improvement in angiographic stenosis. This discrepancy suggested that cholesterol lowering by statins may lead to stabilization of vulnerable plaques rather than reducing stenosis per sé. The predominant effect of statins is to lower lipid levels by inhibiting cholesterol biosynthesis. Besides the lipid lowering effects, statins have also been shown to modulate the inflammatory status and improve endothelial function amongst others, commonly referred to as "pleiotropic effects". In the present review we will discuss different determinants which lead to plaque vulnerability and subsequently we will expand on the plaque stabilizing or "pleiotropic" effects of statin treatment.
Akdim
Fatima
F
Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands.
van Leuven
Sander I
SI
Kastelein
John J P
JJ
Stroes
Erik S G
ES
D000893:Anti-Inflammatory Agents / Q000494:pharmacology* / Q000627:therapeutic use; D050197:Atherosclerosis / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000188:drug therapy; D003713:Dendritic Cells / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D008055:Lipids / Q000097:blood; D008264:Macrophages / Q000187:drug effects; D012422:Rupture, Spontaneous; D013601:T-Lymphocytes / Q000187:drug effects; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D002097:C-Reactive Protein