The advent of statins has brought about significant advances in the management of CVD. Initial studies explored the impact of statins on CAD progression. While angiographic changes were small, the associated clinical responses appeared significant. Later, large, controlled clinical trials showed benefit in the primary and secondary prevention of CAD in patients with elevated serum cholesterol, and more recently, the efficacy of statins has been extended to primary prevention of CAD in subjects with average cholesterol levels.

In addition to lowering LDL and reducing intima-media thickness (IMT), statin treatment has been shown in vitro to exert effects on many other components of atherosclerosis, including plaque thrombogenicity, cell proliferation and migration, endothelial function, and tendency to thrombosis. Statins inhibit LDL oxidation and uptake of oxLDL by macrophages, and inhibit monocyte adhesion to the vascular endothelium. Investigators suggest that the rapid and multivalent effects of statins on determinants of platelet reactivity, coagulation, and endothelial function may also establish a role for these agents in the management of acute coronary syndromes (ACS)..

Blumenthal RS. Statins: effective antiatherosclerotic therapy. Am Heart J. 2000;139:577-583.

Vaughan CJ, Gotto AM Jr, Basson CT. The evolving role of statins in the management of atherosclerosis. J Am Coll Cardiol. 2000;35:1-10.