Is statins’ benefit mediated only through cholesterol reduction?

Meta-analysis of published trials strongly suggested that there may be a cholesterol independent effects.  Some of these effects include:

• Improve endothelial cell function

• Anti-inflammatory effect and antiplatelet effect

• Anti-oxidant effect

• Plaque stabilization

• Antithrombotic effect

Which Statin to Use?

• Only natural statins (simvastatin, pravastatin, and lovastatin) have been shown to prevent first and second MI and first ever stroke.

• There is no direct evidence to support use of synthetic statins for prevention of MI and/or stroke.

Are Statins Interchangeable?

• Statins were classified based on their ability to inhibit HMG CO A reductase.

• There is no established clinical or scientific definition of class effect.

• FDA defines a class as “all products within a class are assumed to be closely related in chemical structure, pharmacology, therapeutic activity, and adverse reactions”.

• Differences have been shown in statins’ ability to inhibit cholesterol accumulation in macrophages.

• Inhibition of SMC varies among the statins.

• Lipophilic (not hydrophilic) statins suppress tissue factor expression, initiator of coagulation.

• Lipophilic (not hydrophilic) statins were shown to impair recovery of myocardial cells after ischemia.

• Atorvastatin has been shown to increase PAI-1 antigen level. It was also shown to increase fibrinogen and produce molecular changes in fibrinogen structure.

• Atorvastatin at higher doses was shown to affect HDL unfavorably.

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The content of these pages was written by Dr. Abdullah Nassief of Washington University School of Medicine, based on a presentation given in October of 2000.

Last Revised: October 31, 2000