Harvard Men's Health Watch

Beyond the coronary arteries: Possible benefits of statin drugs Part II: Specific syndromes

The statins are the best-selling prescription drugs in the United States. That's no surprise, since heart disease is America's leading cause of death, and the statins can reduce the risk of heart attacks and other major cardiac events by up to 37%, with the greatest benefit going to the men at highest risk.

All seven statin drugs act in the same way, by inhibiting the liver enzyme that's responsible for cholesterol production; when the enzyme is blocked, liver cells make less cholesterol, and blood levels of LDL ("bad") cholesterol fall. But the drugs have another benefit: as cholesterol production falls, the liver takes up more cholesterol from the blood, so blood levels fall even further. The statins produce only small elevations in HDL ("good") cholesterol, and only two, atorvastatin (Lipitor) and rosuvastatin (Crestor), lower triglycerides to an important degree.

The statins start to protect the heart rapidly, long before cholesterol levels fall substantially. To understand this speed, and to find out why the statins even help people with normal cholesterol levels, scientists have uncovered many other actions of these medications. The statins have anti-inflammatory and antioxidant properties that may protect the arterial wall from being damaged by cholesterol. They also improve vascular function, helping arteries widen to carry more blood to the heart muscle and other tissues. In addition, the statin drugs stabilize cholesterol-laden arterial plaques, reducing the chance that they will rupture and trigger heart attacks. By inhibiting platelets, the tiny blood cells that initiate blood clotting, statins also help to prevent artery-blocking blood clots. Finally, statin therapy appears to reduce blood viscosity, or "thickness," perhaps facilitating flow through partially blocked arteries.

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