It later emerged that they also possess anti-inflammatory action, and because in the end triumphed over inflammatory hypothesis of atherosclerosis had become major in its treatment, from primary prevention and ending with all the variety of complications.
As a result, clinical use of statins reduced cardiovascular and total mortality, improves quality of life and prognosis for patients with any manifestation of atherosclerosis.
It is not contested that the long-term (two years) continuous treatment with statins slows the progression of atherosclerosis. The first phase of treatment with statins lipid-lowering therapy was in its true sense to target cholesterol levels. It gradually changed the paradigm of treatment, when they began to understand that atherosclerosis may be at a low level of cholesterol. In severe clinical atherosclerosis (coronary, cerebral, either), even with low-cholesterol high-dose statins exert their therapeutic effect and in this have no alternative. With anti-inflammatory effects of statins associated decrease in volume and increase the elasticity of the lipid core with improved properties of the connective tissue sheath of atherosclerotic plaques, slowing down, and in some cases the reverse of their development, improvement of endothelial function, decrease in inflammatory activity with a decrease in the thickness of the intima and media of arteries of muscular and musculocutaneous elastic-type, etc. Statins have a modulating effect on inflammation, with decreases blood levels of C-reactive protein, circulating biochemical markers of inflammation (soluble forms of P-and E-selectin and intercellular adhesion molecules (ICAM-1)) and hemostatic ( tissue plasminogen activator antigen (tPAag), Villebranta factor and thrombomodulin) activity of the endothelium.
Two-pronged hypolipidemic and anti-inflammatory mechanism of action of statins causes a lot of positive clinical effects, at first glance surprising, because these pleiotropic among them? Improvement of cognitive functions, reducing the number and variety of arrhythmias, improve cardiac pump function, mochi brazovatelnoy renal function, reduction in systolic and diastolic blood pressure, improve glucose metabolism in diabetes, even just improving your general health, and many others. These effects are caused by direct action of statins comparable to the hypolipidemic effect, and their assignment to the pleiotropic is purely historical. Moreover, they do not depend on the hypolipidemic effect of the drug.
The main pharmacodynamic effects of statins
- Dilation and prevention of arterial spasm
- Stimulation of angiogenesis
- inhibition of proliferation of vascular smooth muscle cells
- slowing down the formation, development and stabilization of atherosclerotic plaques
- inhibition of platelet aggregation, decrease platelet and red blood cells with a decrease in blood viscosity
- reducing the level of thrombin and stimulation of fibrinolysis, the decrease in the level of the plasminogen activator inhibitors
- increase the synthesis of endothelial
- inhibition of macrophage migration into the vascular wall
- antioxidant effect
- immunosuppressive effect
- reduction of left ventricular hypertrophy
- antiarrhythmic effect
- reduction of albuminuria in diabetes mellitus
- slowing the progression of Alzheimer's disease and dementia
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