PubMed · 13362089
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M A BERKUN, E DONOSO, A GRISHMAN, R H KESSELMAN. 1956. The spatial atrial gradient.. https://doi.org/10.1016/0002-8703(56)90152-1
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In addition to their lipid-modulating properties, statins have a large number of beneficial cardiovascular effects that have emerged over time and that were not anticipated during drug development. The lipid and nonlipid effects act in a concerted way to reduce the ischemic burden of the myocardium and to protect it against injury. By acting on the vessel wall, statins may prevent lesion initiation and repair injuries, enhance myocardial perfusion, slow lesion progression, and prevent coronary occlusion. They may also directly reduce myocardial damage, favor myocardial repair, and protect against immune injury. This review focuses on properties of statins that contribute to their cardioprotective effect. The first section includes information on modulation of vascular tone, endothelial permeability and function, inhibition of complement injury, curbing of foam cell formation, antioxidant and anti-inflammatory properties, and profibrinolytic and anticoagulant activities. The second section relates to reduction of myocardial necrosis, myocardial hypertrophy, blood pressure, and heart failure, as well as mobilization of endothelial progenitor cells for repair, angiogenic effects, and immunomodulation. In many instances, results of in vitro and animal studies have raised expectations and prompted studies in humans. Several clinical trials have confirmed these expectations and have strengthened the value of statins as valuable antiatherosclerotic and cardioprotective agents.
The National Cholesterol Education Program Adult Treatment Panel III has provided a clinical definition for the metabolic syndrome that is practical for use in an office setting. Identification and treatment of the metabolic syndrome is of enormous public health importance because it is associated with a marked elevation in coronary heart disease risk and affects nearly 25% of adults in the United States. First-line therapy is lifestyle modification, which includes body weight reduction, increased physical activity, and moderation of the dietary glycemic load. Drug treatments focusing on the major components of the syndrome (atherogenic dyslipidemia, hypertension, and a prothrombotic state) have demonstrated efficacy for reducing coronary heart disease events. Fibrates seem to be particularly effective in patients for whom a disturbance of the triglyceride-high-density lipoprotein axis is the primary lipid disorder. Fibrates also appear to influence a number of emerging risk factors, including hemostatic and inflammatory markers and indicators of improved vascular wall biology, which may contribute to their cardioprotective effects.
Cardiovascular magnetic resonance (CMR) is widely regarded as capable of providing a cornucopia of detailed diagnostic information. However, of that information, very little is truly unique, and can be obtained by a combination of alternate diagnostic modalities. Given this, it is anticipated that in the short term (1-5 years) CMR will find use primarily as a modality to service patients whose diagnosis is inaccessible to established technologies such as ultrasound and radionuclide imaging. Due to the evolving emphasis on finding new and more efficient approaches to disease detection and prevention, as outlined in a policy-setting speech given by the director of the National Institutes of Health, it is anticipated that the scientific and clinical trial communities will adopt CMR at a more rapid pace due to its inherent dimensional accuracy and comprehensive nature. CMR is particularly well suited to participate in the approaching explosion of nanoparticle technologies, as they are applied to diagnostic and therapeutic approaches. In the longer term (5-10 years), as paradigms of disease detection likely expand beyond evaluation of symptoms and risk factors, the comprehensive nature of information provided by CMR will drive the increase of its use as a primary, first-tier, diagnostic modality. In summary, the use of CMR will become increasingly common, and as understanding of disease processes expand, it will emerge as a diagnostic modality that provides an abundance of unique information.