Altering the pathophysiology of atherosclerosis: the multidimensional role of statins.

The role of low-density lipoprotein cholesterol (LDL-C) in the pathogenesis of atherosclerosis is well recognized. Recent research has documented the importance of inflammation in atherosclerosis formation and disease progression. Lowering LDL-C with HMG-CoA reductase inhibitors ("statins") has been shown to decrease atheroma burden and reduce cardiovascular adverse events in patients with acute coronary syndromes as well as in asymptomatic patients with recognized risk factors. In addition, recent primary prevention studies have shown that aggressively lowering LDL-C with statins-even in people with so-called "normal" LDL-C and few cardiovascular risk factors-can substantially reduce the rate of myocardial infarction, stroke, and other cardiovascular outcomes. The impact of treatment is particularly notable in patients with elevated levels of C-reactive protein, a recognized marker of vascular inflammation.