Vascular Endothelium and Effects of the Statins

Abstract

The vascular endothelium is a dynamic endocrine organ that regulates contractile, secretory, and mitogenic activities in the vessel wall, and hemostatic processes within the vascular lumen. Risk factors for cardiovascular disease, such as cigarette smoking, hypertension, and elevated serum lipid levels, impair endothelial function and lead to the development of atherosclerotic vessels. The potential consequences of endothelial dysfunction are numerous, including myocardial ischemia; plaque rupture and thrombosis, causing unstable angina or myocardial infarction. Several studies suggest that lipid-lowering therapies reduce myocardial ischemia in patients with coronary artery disease. Recent studies suggest that statins reduce cardiovascular events, in part by improving endothelial function. There is increasing evidence, however, that statins may also exert effects beyond cholesterol lowering. Indeed, many of these cholesterol-independent or “pleiotropic” vascular effects of statins appear to involve restoration or improvement of endothelial function through increased bioavailability of nitric oxide, with promotion of re-endothelialization, reduction of oxidative stress, and inhibition of inflammatory responses.