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Cholesterol Medications: Not just to lower your cholesterol levels

Swasti Bhajan Mathur BScPhm, Senior Pharmacist
Rouge Valley Health System
Cardiac Rehabilitation Services
Toronto - August 2003

Cholesterol medications (statins or HMG-CoA Reductase Inhibitors) are used to lower levels of fats (or lipids) in the blood (such as cholesterol and triglycerides). These medications help to lower bad cholesterol (LDL – low density lipoproteins), lower triglycerides and boost good cholesterol (HDL – high density lipoproteins).

Current statins on the Canadian market include:

Atorvastatin Lipitor®
Fluvastatin Lescol®
Lovastatin Mevacor®
Pravastatin Pravachol®
Rosuvastatin Crestor®
Simvastatin Zocor®

However, cholesterol medications do more than just lower cholesterol. Several studies have shown that statin benefits go beyond cholesterol reduction. Other benefits include improvement of endothelial function and stabilization of atherosclerotic plaque. This article will review some of the recent data discovered regarding further beneficial effects of statin medications.

Atherosclerosis is a process where particles of cholesterol and other substances settle inside the endothelium (walls of blood vessels) causing the formation of a plaque or blockage. This build up of plaque is one of the main causes of heart disease and stroke. Plaque builds up and causes blood vessels to become narrower preventing blood from moving through the vessels easily. Plaque can also break off the walls of the blood vessels resulting in the formation of blood clots that can partially or totally block the flow of blood through the vessels. When a blood clot causes total blockage and prevents blood from reaching the heart, this can result in a heart attack. When a blood clot causing total blockage prevents blood from reaching the brain, this can result in a stroke.

The endothelium also plays a role in this process. The endothelium is the innermost lining of the blood vessel and has direct contact with the blood. An unhealthy endothelium contributes to the constriction and thickening of blood vessels. This allows blood cells to accumulate and stick to the blood vessels which contributes to the development of the atherosclerotic plaque. A healthy endothelium has been described as being like a Teflon® coating on the inner walls of the vessel with its non-stick quality enhancing the flow of blood. An unhealthy endothelium instead acts like Velcro® which grabs blood cells and packs them against the inner wall of the blood vessel1.

Research has shown that the beneficial effects of statins has to do with their ability to stabilize an atherosclerotic plaque and improve the endothelial function. Studies have shown that statins can stabilize a plaque by preventing the plaque from fissuring (or breaking). Statins have been theorized to improve the endothelial function by improving the blood flow through the blood vessels that is dependent on the endothelium. In addition, statins may stabilize some of the substances that can affect the endothelium.

In conclusion, statins are very effective medications for improving cholesterol levels (ie total cholesterol, LDL, HDL and triglycerides). In addition to this benefit, more and more research suggests that statins play a greater role through their beneficial effects on atherosclerosis and endothelium.

CCRF would like to thank The Rouge Valley Health System Cardiac Rehabilitation Services for their contribution to the website.

The articles, on the Cardiac Health Foundation of Canada website, are presented with the understanding that the Foundation is providing information only and not rendering medical advise. Please check with your family physician, specialist or health care professional before implementing any of the ideas expressed in these articles.

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