Statins: Mechanism of Action and Usage in Neurology

Abstract

3-hydroxy-3-methylglutaryl coenzym A (HMG-Co A) reductase inhibitors or statins have been known as inhibitors of cholesterol biosynthesis. Large clinical trials and meta-analyses of HMG-CoA reductase inhibitors have demonstrated beneficial effects of statins in the primary and secondary prevention of coronary heart disease in patients with elevated or normal cholesterol levels. These drugs display additional cholesterol-independent or pleiotropic effects including decreasing vascular inflammation, oxidative stress, cell proliferation and thrombogenic response, improving endothelial function and enhancing stability of atherosclerotic plaque. The relationship between serum cholesterol level and stroke incidence has been controversial. However, clinical trials of meta-analyses of statins have demonstrated a relative risk reduction in stroke of 19-32 % in patients with coronary heart disease. Non-fatal stroke risk reduction is more significant. Beneficial effects of statins in stroke risk have not been proven yet with the exception of patients with a history of coronary heart disease. Randomized, placebo-controlled trialsare required for other patients with neurological conditions.