[Statins and cardiovascular diseases]

Statins are utilised in the primary and secondary prevention of coronary heart disease, due to their efficacy at lowering lipid levels. However, statins may also prevent atherosclerosis disease by non-lipid or pleiotropic effects, for example, improving endothelial function by promoting the production of NO. By increasing NO production, statins may interfere with atherosclerosis lesion developement, stabilise plaque, inhibit platlet aggregation, improve blood flow and protect against ischaemia. Therofore, the ability of statins to improve endothelial function through the release of NO may partialy account for their beneficial effects at reducing the incidence of cardiovascular events. Other pleiotropic effects of statins, i.e. immunomedulatory, antiinflammatory, antioxidant and antiendothelin effects, also contribute to the reduction of the incidence of major cardiovascular events. Statins have become the basic drugs in high risk cardiovascular patients with hypercholesterolemia. The ATP III update recommends an optional therapeutic target of LDL-C < 1,8 mmol/L in very high risk patients: those with acute coronary syndrome or those with CHD plus diabetes, the metabolic syndrome, multiple-risk factors, or a poorly controlled risk factor. Studies have demonstrated benefit from lipid lowering irrispective of initial LDL-C levels, including those with average levels at baseline.