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(Circulation. 2000;101:207.)
© 2000 American Heart Association, Inc.


Cardiovascular Drugs

Current Perspectives on Statins

David J. Maron, MD; Sergio Fazio, MD, PhD; MacRae F. Linton, MD

From the Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University, School of Medicine, Nashville, Tenn.

Abstract—Statins (HMG-CoA reductase inhibitors) are used widely for the treatment of hypercholesterolemia. They inhibit HMG-CoA reductase competitively, reduce LDL levels more than other cholesterol-lowering drugs, and lower triglyceride levels in hypertriglyceridemic patients. Statins are well tolerated and have an excellent safety record. Clinical trials in patients with and without coronary heart disease and with and without high cholesterol have demonstrated consistently that statins reduce the relative risk of major coronary events by {approx}30% and produce a greater absolute benefit in patients with higher baseline risk. Proposed mechanisms include favorable effects on plasma lipoproteins, endothelial function, plaque architecture and stability, thrombosis, and inflammation. Mechanisms independent of LDL lowering may play an important role in the clinical benefits conferred by these drugs and may ultimately broaden their indication from lipid-lowering to antiatherogenic agents.


Key Words: statins • hypercholesterolemia • trials • atherosclerosis • coronary disease




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HypertensionHome page
M. Sata, H. Nishimatsu, J.-i. Osuga, K. Tanaka, N. Ishizaka, S. Ishibashi, Y. Hirata, and R. Nagai
Statins Augment Collateral Growth in Response to Ischemia but They Do Not Promote Cancer and Atherosclerosis
Hypertension, June 1, 2004; 43(6): 1214 - 1220.
[Abstract] [Full Text] [PDF]


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CirculationHome page
F. Mach
Statins as Immunomodulatory Agents
Circulation, June 1, 2004; 109(21_suppl_1): II-15 - II-17.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Waehre, A. Yndestad, C. Smith, T. Haug, S. H. Tunheim, L. Gullestad, S. S. Froland, A. G. Semb, P. Aukrust, and J. K. Damas
Increased Expression of Interleukin-1 in Coronary Artery Disease With Downregulatory Effects of HMG-CoA Reductase Inhibitors
Circulation, April 27, 2004; 109(16): 1966 - 1972.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
L. M. Blanco-Colio, J. L. Martin-Ventura, J. M. Sol, C. Diaz, G. Hernandez, and J. Egido
Decreased circulating Fas ligand in patients with familial combined hyperlipidemia or carotid atherosclerosis: Normalization by atorvastatin
J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1188 - 1194.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
J. Haendeler, J. Hoffmann, J. F. Diehl, M. Vasa, I. Spyridopoulos, A. M. Zeiher, and S. Dimmeler
Antioxidants Inhibit Nuclear Export of Telomerase Reverse Transcriptase and Delay Replicative Senescence of Endothelial Cells
Circ. Res., April 2, 2004; 94(6): 768 - 775.
[Abstract] [Full Text] [PDF]


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J CARDIOVASC PHARMACOL THERHome page
A. P. Tambaki, E. Rizos, V. Tsimihodimos, A. D. Tselepis, and M. Elisaf
Effects of Antihypertensive and Hypolipidemic Drugs on Plasma and High-Density Lipoprotein-Associated Platelet Activating Factor-Acetylhydrolase Activity
Journal of Cardiovascular Pharmacology and Therapeutics, April 1, 2004; 9(2): 91 - 95.
[Abstract] [PDF]


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The Annals of PharmacotherapyHome page
A J. Kahri, M. M Valkonen, M. K. Vuoristo, and P. J Pentikainen
Rhabdomyolysis associated with concomitant use of simvastatin and clarithromycin
Ann. Pharmacother., April 1, 2004; 38(4): 719 - 719.
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Cardiovasc ResHome page
K. Kumagai, H. Nakashima, and K. Saku
The HMG-CoA reductase inhibitor atorvastatin prevents atrial fibrillation by inhibiting inflammation in a canine sterile pericarditis model
Cardiovasc Res, April 1, 2004; 62(1): 105 - 111.
[Abstract] [Full Text] [PDF]


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J. Clin. Endocrinol. Metab.Home page
P. A. Economides, A. Caselli, E. Tiani, L. Khaodhiar, E. S. Horton, and A. Veves
The Effects of Atorvastatin on Endothelial Function in Diabetic Patients and Subjects at Risk for Type 2 Diabetes
J. Clin. Endocrinol. Metab., February 1, 2004; 89(2): 740 - 747.
[Abstract] [Full Text] [PDF]


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J CARDIOVASC PHARMACOL THERHome page
B. N. Singh
Survival Advantage with Cardiovascular Drugs: Are they Real?
Journal of Cardiovascular Pharmacology and Therapeutics, December 1, 2003; 8(4): 249 - 251.
[PDF]


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CirculationHome page
K. Shimizu, M. Aikawa, K. Takayama, P. Libby, and R. N. Mitchell
Direct Anti-Inflammatory Mechanisms Contribute to Attenuation of Experimental Allograft Arteriosclerosis by Statins
Circulation, October 28, 2003; 108(17): 2113 - 2120.
[Abstract] [Full Text] [PDF]


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StrokeHome page
S. C. Johnston and J. D. Easton
Are Patients With Acutely Recovered Cerebral Ischemia More Unstable?
Stroke, October 1, 2003; 34(10): 2446 - 2450.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Nishimura, L. T. Vaszar, J. L. Faul, G. Zhao, G. J. Berry, L. Shi, D. Qiu, G. Benson, R. G. Pearl, and P. N. Kao
Simvastatin Rescues Rats From Fatal Pulmonary Hypertension by Inducing Apoptosis of Neointimal Smooth Muscle Cells
Circulation, September 30, 2003; 108(13): 1640 - 1645.
[Abstract] [Full Text] [PDF]


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DiabetesHome page
M. R. Nangle, M. A. Cotter, and N. E. Cameron
Effects of Rosuvastatin on Nitric Oxide-Dependent Function in Aorta and Corpus Cavernosum of Diabetic Mice: Relationship to Cholesterol Biosynthesis Pathway Inhibition and Lipid Lowering
Diabetes, September 1, 2003; 52(9): 2396 - 2402.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
F. Mulhaupt, C. M Matter, B. R Kwak, G. Pelli, N. R Veillard, F. Burger, P. Graber, T. F Luscher, and F. Mach
Statins (HMG-CoA reductase inhibitors) reduce CD40 expression in human vascular cells
Cardiovasc Res, September 1, 2003; 59(3): 755 - 766.
[Abstract] [Full Text] [PDF]


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HeartHome page
S van Wissen, T J Smilde, M D Trip, T. de Boo, J J P Kastelein, and A F H Stalenhoef
Long term statin treatment reduces lipoprotein(a) concentrations in heterozygous familial hypercholesterolaemia
Heart, August 1, 2003; 89(8): 893 - 896.
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CirculationHome page
E. Bruckert, P. Giral, and P. Tellier
Perspectives in Cholesterol-Lowering Therapy: The Role of Ezetimibe, a New Selective Inhibitor of Intestinal Cholesterol Absorption
Circulation, July 1, 2003; 107(25): 3124 - 3128.
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CirculationHome page
P. E. Szmitko, P. W.M. Fedak, R. D. Weisel, D. J. Stewart, M. J.B. Kutryk, and S. Verma
Endothelial Progenitor Cells: New Hope for a Broken Heart
Circulation, June 24, 2003; 107(24): 3093 - 3100.
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Arch Intern MedHome page
Z. S. Tan, S. Seshadri, A. Beiser, P. W. F. Wilson, D. P. Kiel, M. Tocco, R. B. D'Agostino, and P. A. Wolf
Plasma Total Cholesterol Level as a Risk Factor for Alzheimer Disease: The Framingham Study
Arch Intern Med, May 12, 2003; 163(9): 1053 - 1057.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
T. Waehre, J. K. Damas, L. Gullestad, A. M. Holm, T. R. Pedersen, K. E. Arnesen, H. Torsvik, S. S. Froland, A. G. Semb, and P.a. Aukrust
Hydroxymethylglutaryl coenzyme a reductase inhibitors down-regulate chemokines and chemokine receptors in patients with coronary artery disease
J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1460 - 1467.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
S. H. Wilson, A. R. Chade, A. Feldstein, T. Sawamura, C. Napoli, A. Lerman, and L. O. Lerman
Lipid-lowering-independent effects of simvastatin on the kidney in experimental hypercholesterolaemia
Nephrol. Dial. Transplant., April 1, 2003; 18(4): 703 - 709.
[Abstract] [Full Text] [PDF]


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Arch Intern MedHome page
J.-C. Corvol, A. Bouzamondo, M. Sirol, J.-S. Hulot, P. Sanchez, and P. Lechat
Differential Effects of Lipid-Lowering Therapies on Stroke Prevention: A Meta-analysis of Randomized Trials
Arch Intern Med, March 24, 2003; 163(6): 669 - 676.
[Abstract] [Full Text] [PDF]


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JEMHome page
O. Aktas, S. Waiczies, A. Smorodchenko, J. Dorr, B. Seeger, T. Prozorovski, S. Sallach, M. Endres, S. Brocke, R. Nitsch, et al.
Treatment of Relapsing Paralysis in Experimental Encephalomyelitis by Targeting Th1 Cells through Atorvastatin
J. Exp. Med., March 17, 2003; 197(6): 725 - 733.
[Abstract] [Full Text] [PDF]


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Arch Intern MedHome page
C. M. Ballantyne, A. Corsini, M. H. Davidson, H. Holdaas, T. A. Jacobson, E. Leitersdorf, W. Marz, J. P. D. Reckless, and E. A. Stein
Risk for Myopathy With Statin Therapy in High-Risk Patients
Arch Intern Med, March 10, 2003; 163(5): 553 - 564.
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EndocrinologyHome page
T. Maeda, T. Kawane, and N. Horiuchi
Statins Augment Vascular Endothelial Growth Factor Expression in Osteoblastic Cells via Inhibition of Protein Prenylation
Endocrinology, February 1, 2003; 144(2): 681 - 692.
[Abstract] [Full Text] [PDF]


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StrokeHome page
K. Gertz, U. Laufs, U. Lindauer, G. Nickenig, M. Bohm, U. Dirnagl, and M. Endres
Withdrawal of Statin Treatment Abrogates Stroke Protection in Mice
Stroke, February 1, 2003; 34(2): 551 - 557.
[Abstract] [Full Text] [PDF]


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J. Leukoc. Biol.Home page
Y. Majlesi, P. Samorapoompichit, A. W. Hauswirth, G.-H. Schernthaner, M. Ghannadan, M. Baghestanian, A. Rezaie-Majd, R. Valenta, W. R. Sperr, H.-J. Buhring, et al.
Cerivastatin and atorvastatin inhibit IL-3-dependent differentiation and IgE-mediated histamine release in human basophils and downmodulate expression of the basophil-activation antigen CD203c/E-NPP3
J. Leukoc. Biol., January 1, 2003; 73(1): 107 - 117.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
K. K. W. Chan, A. M. Oza, and L. L. Siu
The Statins as Anticancer Agents
Clin. Cancer Res., January 1, 2003; 9(1): 10 - 19.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
W. Dichtl, J. Dulak, M. Frick, H. F. Alber, S. P. Schwarzacher, M. P.S. Ares, J. Nilsson, O. Pachinger, and F. Weidinger
HMG-CoA Reductase Inhibitors Regulate Inflammatory Transcription Factors in Human Endothelial and Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, January 1, 2003; 23(1): 58 - 63.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
V. Schachinger and A. M. Zeiher
Atherogenesis--recent insights into basic mechanisms and their clinical impact
Nephrol. Dial. Transplant., December 1, 2002; 17(12): 2055 - 2064.
[Full Text] [PDF]


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J. Lipid Res.Home page
R. Breitling and S. K. Krisans
A second gene for peroxisomal HMG-CoA reductase? A genomic reassessment
J. Lipid Res., December 1, 2002; 43(12): 2031 - 2036.
[Abstract] [Full Text] [PDF]


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Am. J. Respir. Crit. Care Med.Home page
T. Nishimura, J. L. Faul, G. J. Berry, L. T. Vaszar, D. Qiu, R. G. Pearl, and P. N. Kao
Simvastatin Attenuates Smooth Muscle Neointimal Proliferation and Pulmonary Hypertension in Rats
Am. J. Respir. Crit. Care Med., November 15, 2002; 166(10): 1403 - 1408.
[Abstract] [Full Text] [PDF]