Statins and vein graft failure in coronary bypass surgery.
Saphenous vein grafts used in coronary artery bypass graft surgery suffer from lower patency rates compared to left internal mammary artery. A number of clinical trials and observational studies have demonstrated a significant benefit of statin treatment on vein graft patency. Aside from their well-known lipid-lowering capacities, statins exert pleiotropic effects by direct inhibition of the mevalonate pathway in the wall of these grafts. This leads to reduced geranylgeranylation of small GTPases such as Rho and Rac. Through this LDL-independent mechanism, statins improve endothelial function and reduce vascular inflammation and oxidative stress, inhibiting also smooth muscle cell proliferation and migration. Although the existing evidence supports a beneficial effect of statins on vein grafts biology, more clinical trials focused on the effect of aggressive statin treatment on vein graft patency are required, in order to safely translate this strategy into clinical practice.
Department of Cardiovascular Medicine, University of Oxford, West Wing Level 6, John Radcliffe Hospital, Headley way, Oxford OX3 9DU, UK.
Marios
M
Margaritis
Keith M
KM
Channon
Charalambos
C
Antoniades
D000818:Animals; D001026:Coronary Artery Bypass; D006083:Graft Occlusion, Vascular / Q000517:prevention & control*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D012501:Saphenous Vein / Q000637:transplantation; D013927:Thrombosis / Q000517:prevention & control; D014654:Vascular Patency / Q000187:drug effects
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors