[Therapy with CSE inhibitors--more than lipid lowering?]

An elevated plasma cholesterol concentration is an established risk factor for coronary heart disease. Dietary and drug interventions with fibrate, nicotinic acid and colestyramine have resulted in a decreased rate of major coronary events but failed to decrease mortality. Studies using the more potent lipid lowering statins have shown remarkable results in primary (WOSCOPS, AFCAPS, TexCAPS) and secondary prevention (4S, CARE, LIPID). The use of these drugs reduced the risk for coronary events as well as the need for interventions. Furthermore, improvement of angina has been shown in several studies. In high-risk patients coronary heart disease associated mortality and overall mortality was reduced. Lowering of cholesterol was shown to be effective in women, older people and diabetics. Lipid lowering improves prognosis after heart transplant and could be an alternative to PTCA. Furthermore it was also shown that cholesterol lowering reduces the incidence of stroke. New mechanisms are discussed to explain the rapid onset of clinical improvement. Among these are: influences on inflammatory processes in the plaque, on vascular smooth muscle activity, on coagulation and on endothelial dysfunction.