Statins: effects beyond cholesterol lowering

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Abstract
Recent large‐scale placebo‐controlled clinical trials have established beyond doubt the benefits of 3‐hydroxy‐3‐methyl‐glutaryl coenzyme A (HMG‐Co A) reductase inhibitors (statins) in the primary and secondary prevention of coronary heart disease [1]. The role of hypercholesterolaemia in the pathogenesis of atherosclerosis is also well established and statins are the most powerful available agents to safely reduce blood cholesterol levels. However, the greater than expected success of statin therapy has raised the possibility that certain beneficial effects go beyond their ability to reduce circulating cholesterol levels [2]. For example, the clinical benefits of statin therapy appear disproportionate to the improvement in atherosclerotic lesions demonstrated in angiographic studies [3]. Therefore, statins may reduce cardiovascular events by mechanisms different from regression of coronary atherosclerosis. Second, the rate of clinical events in some trials in from treated groups was lower than expected from estimations based on Framingham equations using in‐trial cholesterol levels, whereas estimations were highly accurate for patients assigned to placebo [4]. Finally, case‐control studies recently generated interesting data suggesting that statins may provide additional benefits in some (apparently) unrelated conditions such as the prevention of bone mass loss [5], the development of new onset diabetes mellitus [6], and dementia [7].