Pleiotropic effects of a drug are actions other than those for which the agent was specifically developed. These effects may be related or unrelated to the primary mechanism of action of the drug, and they are usually unanticipated. Pleiotropic effects may be undesirable (such as side effects or toxicity), neutral, or, as is especially the case with HMG-CoA reductase inhibitors (statins), beneficial. Pleiotropic effects of statins include improvement of endothelial dysfunction, increased nitric oxide bioavailability, antioxidant properties, inhibition of inflammatory responses, and stabilization of atherosclerotic plaques. These and several other emergent properties could act in concert with the potent low-density lipoprotein cholesterol-lowering effects of statins to exert early as well as lasting cardiovascular protective effects. Understanding the pleiotropic effects of statins is important to optimize their use in treatment and prevention of cardiovascular disease.
As HMG-CoA reductase inhibitors (statins) became more widely used in greater numbers of patients, their effects beyond lipid lowering began to emerge. Such pleiotropic effects include improvement of endothelial dysfunction, increased nitric oxide bioavailability, antioxidant effects, antiinflammatory properties, and stabilization of atherosclerotic plaques. Additional effects of growing interest include the ability to recruit endothelial progenitor cells (EPCs), a putative immunosuppressive activity, and inhibition of cardiac hypertrophy. Research indicates that some of the pleiotropic effects of statins may be unrelated to the cholesterol-lowering properties of the drugs. Others may even be fully dissociated from inhibition of HMG-CoA reductase, and many take place at very low drug concentrations. This review focuses on effects that have special cardiovascular relevance. Understanding the full spectrum of benefits associated with statin therapy may allow better therapeutic application and foster the early use of statins in acute coronary syndromes.