Statin Therapy-Evidence Beyond Lipid Lowering Contributing to Plaque Stability

Primarily statin drugs inhibit hepatic 3-hydroxy 3-methylglutaryl coenzyme A (HMG-CoA)reductase, which is responsible for the reduction in circulating low-density lipoprotein (LDL) cholesterol.Several findings from recent research studies indicate that statins have multiple actions that favorablyinfluence key factors involved in the atherogenic process. These so-called pleiotropic properties affect variousaspects of cell function, inflammation, coagulation, and vasomotor activity. These effects are mediated eitherindirectly through LDL cholesterol reduction or via a direct effect on cellular functions. Such actions maycontribute to the early cardiovascular benefit observed in several outcome trials with statin drugs therapy.Although many of the pleiotropic properties of statins may be a class effect, some may be unique to certainagents and account for differences in their pharmacological activity. This review summarise the results of the major outcome trials of statins and non-statins therapy and thepossible mechanisms beyond lipid lowering contributing to plaque stability.