Simvastatin: two decades in a circle

Simvastatin is an agent of the 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor group of drugs. It is administrated orally once a day in doses of 5-80 mg. Although its main action is to reduce total and low-density lipoprotein (LDL) cholesterol, it is able to reduce triglycerides and increase high-density lipoprotein cholesterol levels, though at a lower extent. Beyond this action, studies enrolled with simvastatin have shown beneficial effect on endothelial function, smooth muscle cell function, hemostasis, vascular wall function, LDL oxidation, and inflammation. All these actions mentioned above are known as pleiotropic effects. In this review, we will present all these effects, as well as the beneficial effects on atherogenesis and the reduction in cardiovascular morbidity and mortality related to simvastatin.