Statins – Do we really know all mechanisms of action of this group of drugs?

Abstract

The role of statins in the treatment and prevention of cardiovascular diseases, such as coronary artery disease, acute coronary syndromes, diabetes or stroke is well established. However, there are still many questions regarding the role of statins in patients with heart failure (HF)/cardiomyopathy (CM), hypertension, atrial fibrillation (AF) and chronic kidney disease (CKD). As for patients with HF/CM inhibition of inflammation, reducing endothelial dysfunction might comprise part of the underlying mechanisms leading to the improvement of left ventricular function and exercise tolerance in these groups of patients. Therefore the candidates for statin therapy with HF/CM should be in New York Heart Association class II or III and should have normal or increased levels of lipids. We should avoid reducing lipids levels in these patients. At present, it is also difficult to unequivocally assess the impact of statins on blood pressure (BP). However, according to most available studies, the impact of statins on the decrease in BP is slight, but significant, especially among patients with hypertension. Moreover statins significantly reduce cardiovascular events in patients with hypertension. Although the results of trials concerning the use of statins in CKD patients are conflicting, it is suggested that the benefits of statin use outweigh the drawbacks in patients with early-stage CKD, when the benefits can be effectively predicted. However, available large randomized clinical trials suggest a lack of efficacy in patients on renal replacement therapy. We also needs further data on the role of statins on AF, however the existing studies suggest beneficial impact of statins in these patients.