Does it matter whether or not a lipid-lowering agent inhibits Rho kinase?

Lipid-lowering agents, such as 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, also known as statins, have been shown to reduce cardiovascular events. However, evidence from recent clinical trials suggests that some of the beneficial effects of statins may be unrelated to changes in low-density lipoprotein cholesterol. In animal studies, many of the cholesterol-independent or "pleiotropic" effects of statins are mediated by inhibition of Rho kinase (ROCK). Indeed, ROCK has been implicated in the regulation of vascular tone, proliferation, inflammation, and oxidative stress. To what extent ROCK activity is inhibited in patients on lipid-lowering therapy, and in particular on statins, is not known, but it may have important clinical and therapeutic implications. This review attempts to make the case that, in addition to lipid lowering, inhibition of ROCK contributes to some of the benefits of statin therapy in patients with cardiovascular disease.