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Because serum cholesterol level is strongly associated with coronary heart disease, it has been generally assumed that cholesterol reduction by 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors or statins is the predominant mechanism underlying their beneficial effects. However, large prospective trials with statins suggest that these agents may have beneficial effects in cardiovascular disease in addition to their cholesterol-lowering effects. These so-called cholesterol-independent or “pleiotropic” effects include improving or restoring endothelial function, decreasing oxidative stress and inflammation, enhancing the stability of atherosclerotic plaques, and inhibiting the thrombogenic response in the vascular wall (Table). Many of these effects may explain some of the rapid actions of statin therapy on tissue perfusion in acute coronary syndrome and ischemic stroke, irrespective of baseline cholesterol levels. View this table:ffects of Statins on the Vascular Wall Recently, statins have also been found to increase the number of circulating endothelial progenitor cells (EPCs).1 EPCs augment ischemia-induced neovascularization,2 accelerate re-endothelialization after carotid balloon injury,3 and improve post-ischemic cardiac function.4 Indeed, statins …

Statin Therapy: Having the Good Without the Bad