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Lipid-independent pleiotropic effects of statins in the management of acute coronary coronary syndromes

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Acute coronary syndromes involve a complex interplay between the vessel wall, inflammatory cells, and the coagulation cascade. Statins possess beneficial effects that are independent of low-density lipoprotein cholesterol lowering and that have favorable effects on inflammation, the endothelium, and the coagulation cascade. There is now accumulating evidence that these lipid-independent pleiotropic effects are clinically relevant in the management of acute coronary syndromes.

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References and Recommended Reading

  1. Law MR, Wald NJ: Risk factor thresholds: their existence under scrutiny. BMJ 2002, 324:1570–1576.

    Article  PubMed  CAS  Google Scholar 

  2. Baigent C, Keech A, Kearney PM, et al.: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005, 366:1267–1278.

    Article  PubMed  CAS  Google Scholar 

  3. Ray KK, Cannon CP: Time to benefit: an emerging concept for assessing the efficacy of statin therapy in cardiovascular disease. Crit Pathways Cardiol 2005, 4:43–45.

    Article  Google Scholar 

  4. Buchwald H, Varco RL, Matts JP, et al.: Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of the Hyperlipidemias (POSCH). N Engl J Med 1990, 323:946–955.

    Article  PubMed  CAS  Google Scholar 

  5. Schwartz GG, Olsson AG, Ezekowitz MD, et al.: Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 2001, 285:1711–1718.

    Article  PubMed  CAS  Google Scholar 

  6. Cannon CP, Braunwald E, McCabe CH, et al.: Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004, 350:1495–1504.

    Article  PubMed  CAS  Google Scholar 

  7. Ray KK, Cannon CP, McCabe CH, et al.: Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol 2005, 46:1405–1410.

    Article  PubMed  CAS  Google Scholar 

  8. Thompson PL, Meredith I, Amerena J, et al.: Effect of pravastatin compared with placebo initiated within 24 hours of onset of acute myocardial infarction or unstable angina: the Pravastatin in Acute Coronary Treatment (PACT) trial. Am Heart J 2004, 148:e2.

    Article  PubMed  Google Scholar 

  9. Briel M, Schwartz GG, Thompson PL, et al.: Effects of early treatment with statins on short-term clinical outcomes in acute coronary syndromes: a meta-analysis of randomized controlled trials. JAMA 2006, 295:2046–2056.

    Article  PubMed  CAS  Google Scholar 

  10. Chen L, Chester MR, Crook R, Kaski JC: Differential progression of complex culprit stenoses in patients with stable and unstable angina pectoris. J Am Coll Cardiol 1996, 28:597–603.

    Article  PubMed  CAS  Google Scholar 

  11. Rioufol G, Finet G, Ginon I, et al.: Multiple atherosclerotic plaque rupture in acute coronary syndrome: a three-vessel intravascular ultrasound study. Circulation 2002, 106:804–808.

    Article  PubMed  CAS  Google Scholar 

  12. Naghavi M, Libby P, Falk E, et al.: From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 2003, 108:1664–1672.

    Article  PubMed  Google Scholar 

  13. Naghavi M, Libby P, Falk E, et al.: From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part II. Circulation 2003, 108:1772–1778.

    Article  PubMed  Google Scholar 

  14. Fox KA, Poole-Wilson PA, Henderson RA, et al.: Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Randomized Intervention Trial of unstable Angina. Lancet 2002, 360:743–751.

    Article  PubMed  CAS  Google Scholar 

  15. Ridker PM, Rifai N, Pfeffer MA, et al.: Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1998, 98:839–844.

    PubMed  CAS  Google Scholar 

  16. Wong B, Lumma WC, Smith AM, et al.: Statins suppress THP-1 cell migration and secretion of matrix metalloproteinase 9 by inhibiting geranylgeranylation. J Leukoc Biol 2001, 69:959–962.

    PubMed  CAS  Google Scholar 

  17. Laufs U, La Fata V, Plutzky J, Liao JK: Upregulation of endothelial nitric oxide synthase by HMG CoA reductase inhibitors. Circulation 1998, 97:1129–1135.

    PubMed  CAS  Google Scholar 

  18. Omori H, Nagashima H, Tsurumi Y, et al.: Direct in vivo evidence of a vascular statin: a single dose of cerivastatin rapidly increases vascular endothelial responsiveness in healthy normocholesterolaemic subjects. Br J Clin Pharmacol 2002, 54:395–399.

    Article  PubMed  CAS  Google Scholar 

  19. Hernandez-Perera O, Perez-Sala D, Navarro-Antolin J, et al.: Effects of the 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, atorvastatin and simvastatin, on the expression of endothelin-1 and endothelial nitric oxide synthase in vascular endothelial cells. J Clin Invest 1998, 101:2711–2719.

    Article  PubMed  CAS  Google Scholar 

  20. Fichtlscherer S, Rosenberger G, Walter DH, et al.: Elevated C-reactive protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease. Circulation 2000, 102:1000–1006.

    PubMed  CAS  Google Scholar 

  21. Dimmeler S, Aicher A, Vasa M, et al.: HMG-CoA reductase inhibitors (statins) increase endothelial progenitor cells via the PI 3-kinase/Akt pathway. J Clin Invest 2001, 108:391–397.

    PubMed  CAS  Google Scholar 

  22. Walter DH, Rittig K, Bahlmann FH, et al.: Statin therapy accelerates reendothelialization: a novel effect involving mobilization and incorporation of bone marrow-derived endothelial progenitor cells. Circulation 2002, 105:3017–3024.

    Article  PubMed  CAS  Google Scholar 

  23. Vasa M, Fichtlscherer S, Adler K, et al.: Increase in circulating endothelial progenitor cells by statin therapy in patients with stable coronary artery disease. Circulation 2001, 103:2885–2890.

    Article  PubMed  CAS  Google Scholar 

  24. Assmus B, Urbich C, Aicher A, et al.: HMG-CoA reductase inhibitors reduce senescence and increase proliferation of endothelial progenitor cells via regulation of cell cycle regulatory genes. Circ Res 2003, 92:1049–1055.

    Article  PubMed  CAS  Google Scholar 

  25. Dichtl W, Dulak J, Frick M, et al.: HMG-CoA reductase inhibitors regulate inflammatory transcription factors in human endothelial and vascular smooth muscle cells. Arterioscler Thromb Vasc Biol 2003, 23:58–63.

    Article  PubMed  CAS  Google Scholar 

  26. Seljeflot I, Tonstad S, Hjermann I, Arnesen H: Reduced expression of endothelial cell markers after 1 year treatment with simvastatin and atorvastatin in patients with coronary heart disease. Atherosclerosis 2002, 162:179–185.

    Article  PubMed  CAS  Google Scholar 

  27. Paleolog EM, Crossman DC, McVey JH, Pearson JD: Differential regulation by cytokines of constitutive and stimulated secretion of von Willebrand factor from endothelial cells. Blood 1990, 75:688–695.

    PubMed  CAS  Google Scholar 

  28. Nakagomi A, Freedman SB, Geczy CL: Interferon-gamma and lipopolysaccharide potentiate monocyte tissue factor induction by C-reactive protein: relationship with age, sex, and hormone replacement treatment. Circulation 2000, 101:1785–1791.

    PubMed  CAS  Google Scholar 

  29. Eto M, Kozai T, Cosentino F, et al.: Statin prevents tissue factor expression in human endothelial cells: role of Rho/Rho-kinase and Akt pathways. Circulation 2002, 105:1756–1759.

    Article  PubMed  CAS  Google Scholar 

  30. Youssef S, Stuve O, Patarroyo JC, et al.: The HMG-CoA reductase inhibitor, atorvastatin, promotes a Th2 bias and reverses paralysis in central nervous system autoimmune disease. Nature 2002, 420:78–84.

    Article  PubMed  CAS  Google Scholar 

  31. Vollmer T, Key L, Durkalski V, et al.: Oral simvastatin treatment in relapsing-remitting multiple sclerosis. Lancet 2004, 363:1607–1608.

    Article  PubMed  CAS  Google Scholar 

  32. Wolozin B, Kellman W, Ruosseau P, et al.: Decreased prevalence of Alzheimer disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch Neurol 2000, 57:1439–1443.

    Article  PubMed  CAS  Google Scholar 

  33. McCarey DW, McInnes IB, Madhok R, et al.: Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double-blind, randomised placebo-controlled trial. Lancet 2004, 363:2015–2021.

    Article  PubMed  CAS  Google Scholar 

  34. Wenke K, Meiser B, Thiery J, et al.: Simvastatin initiated early after heart transplantation: 8-year prospective experience. Circulation 2003, 107:93–97.

    Article  PubMed  CAS  Google Scholar 

  35. De Lemos JA, Blazing MA, Wiviott SD, et al.: Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z Trial. JAMA 2004, 292:1307–1316.

    Article  PubMed  Google Scholar 

  36. Wiviott SD, de Lemos JA, Cannon CP, et al.: A tale of two trials: a comparison of the post-acute coronary syndrome lipid-lowering trials A to Z and PROVE IT-TIMI 22. Circulation 2006, 113:1406–1414.

    Article  PubMed  CAS  Google Scholar 

  37. Ridker PM, Cannon CP, Morrow D, et al.: C-reactive protein levels and outcomes after statin therapy. The Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. N Engl J Med 2005, 352:20–28.

    Article  PubMed  CAS  Google Scholar 

  38. Morrow DA, de Lemos JA, Sabatine MS, et al.: Clinical relevance of C-reactive protein during follow-up of patients with acute coronary syndromes in the Aggrastat-to-Zocor Trial. Circulation 2006, 114:281–288.

    Article  PubMed  CAS  Google Scholar 

  39. Ray KK, Cannon CP, Cairns R, et al.: Relationship between uncontrolled risk factors and C-reactive protein levels in patients receiving standard or intensive statin therapy for acute coronary syndromes in the PROVE IT-TIMI 22 trial. J Am Coll Cardiol 2005, 46:1417–1424.

    Article  PubMed  CAS  Google Scholar 

  40. Cannon CP, Steinberg BA, Murphy SA, et al.: Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006, 48:438–445.

    Article  PubMed  CAS  Google Scholar 

  41. Scirica BM, Morrow DA, Cannon CP, et al.: Intensive statin therapy and the risk of hospitalization for heart failure after an acute coronary syndrome in the PROVE IT-TIMI 22 study. J Am Coll Cardiol 2006, 47:2326–2331.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Kausik K. Ray.

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Ray, K.K., Cannon, C.P. Lipid-independent pleiotropic effects of statins in the management of acute coronary coronary syndromes. Curr Treat Options Cardio Med 9, 46–51 (2007). https://doi.org/10.1007/s11936-007-0050-1

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