Statins have the ability to decrease biosynthesis of cholesterol
as they prevent synthesis of the cholesterol precursor, mevalonate, and inhibit
3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) in the liver 1, 2. Through
the last three decades, an extensive research in literature focused on protective
effects of statins in patients with cardiovascular disease (CVD) independent of
lowering low density lipoprotein-cholesterol (LDL-C) 3, 4.
Statins can exert their favorable pleiotropic effects
through increasing expression of atheroprotective genes, inhibition of
pro-inflammatory mediators, protection of endothelium, enhancing the stability
of atherosclerotic plaques, inhibiting platelet aggregation, increasing nitric
oxide bioavailability, reducing adhesion molecules, decreasing circulating
biomarkers of oxidative stress and inflammation, inhibiting thrombogenic
response 5, 6.
In clinical practice, statins have a potential protective
role in primary and secondary prevention of all-cause death and major cardiovascular
events 7. To prevent occurrence of atherosclerotic cardiovascular disease, statin
therapy is an effective intervention in addition to modifications of risk factors
In coronary artery disease (CAD) patients with high-risk
for cardiovascular events, recommendations of statins differ between
guidelines. Although attainment of LDL-C goal of 70 mg/dl is recommended by
many guidelines 9,10, the American College of Cardiology/American Heart
Association (ACC/AHA) guideline recommends the use of high-intensity statins in
acute coronary syndrome (ACS) with repeated measurement of lipid levels11.
In last years, a debate exists about use of statins in CAD
patients regarding the real-life applications, patient eligibility, effects of high-intensity
statins 12, 13, role of combined therapy with other lipid-lowering agents, association
with outcomes after coronary artery revascularization 15, and the residual
risk for CAD 16. Therefore, this review of the current literature focuses on the
debates concerning the role of statin therapy in patients with CAD.