Insights into early and rapid effects of statin therapy after coronary interventions

Recent trials provide a wealth of data documenting the benefit of cholesterol-lowering therapy with statins in both primary and secondary prevention. A growing body of evidence indicates that statins possess pleiotropic effects - independent of, or at least in addition to their lipid-lowering capacity, including inhibition of smooth muscle cell proliferation and subsequently neointimal proliferation, platelet aggregation as well as antiinflammatory and direct beneficial effects on endothelial function. The current review summarizes recent findings in non-randomized and randomized trials assessing the efficacy of statin therapy following coronary interventions with or without stent implantation. It highlights the efficacy of statins in the settings of acute coronary syndromes. Current management of acute coronary syndromes requires early administration in combination with acute interventions. High risk patients which receive the greatest benefit could be identified by measuring serum markers such as preprocedural C-reactive protein levels. The present article also describes important novel actions of statins supporting the early initiation of statins post intervention, such as the stimulation of reendothelialization - a crucial step in the healing process of the vascular wall - which is mediated at least in part by mobilization of bone-marrow derived endothelial progenitor cells.