[Atherosclerosis: disputable and unsolved problems in the first decade of the XXI century]

Area of Science:

• Biochemistry
• Cardiovascular Medicine
• Pharmacology

Context:

• The late 20th century revealed key mechanisms of human cholesterol metabolism and the genetic basis of familial hypercholesterolemia.
• Statins, available since the early 1990s, effectively lower blood cholesterol but do not fully resolve atherosclerosis.
• Atherosclerosis involves complex processes including vascular wall inflammation, lipid peroxidation, and smooth muscle cell proliferation.

Purpose:

• To investigate the multifaceted roles of statins beyond cholesterol reduction.
• To explore the impact of statins on vascular inflammation, peroxidation, and smooth muscle cell proliferation.
• To evaluate the efficacy of novel therapeutic agents for atherosclerosis.

Summary:

• Cholesterol metabolism and familial hypercholesterolemia mechanisms were elucidated by the end of the 20th century.
• Statins, while effective cholesterol-lowering drugs, exhibit additional pleiotropic effects.
• These effects include modulation of vascular inflammation, peroxidation, and smooth muscle cell proliferation, necessitating further research.

Impact:

• Highlights the need for deeper understanding of statin pleiotropic effects in atherosclerosis.
• Emphasizes the importance of investigating these mechanisms for developing more effective anti-atherosclerotic therapies.
• Suggests a pathway for future research into innovative drugs targeting complex atherosclerotic pathways.