The Use of Statins in Atherosclerotic Cardiovascular Disease

Abstract

Over the last decade, therapy with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) has evolved as much as the context in which these agents have developed. Advances in knowledge of molecular mechanisms of disease have led to major paradigm shifts in our understanding of atherosclerosis, whereas results of major clinical trials have provided invaluable lessons for the use of statins in clinical practice. The notion of culprit lesion, the importance of endothelial dysfunction, and the contribution of inflammation and oxidation to atherogenesis have become the focus of attention, raising new questions about the beneficial cardiovascular attributes of statins. In fact, the target for statin therapy is gradually evolving from low-density lipoprotein cholesterol alone toward atherosclerosis at large-another paradigm shift.