3-Hydroxy-3-methylglutaryl
coenzyme A (
HMG-CoA) reductase inhibitors (
statins) are greatly contributed to the treatment of
hypercholesterolemia, and constitute an important part of comprehensive strategies for the treatment of
cardiovascular disease in the 21st century. Particularly, a strategy for preventing
acute coronary syndrome (ACS), the most important complication of
hyperlipidemia, is urgently needed. Recent research has revealed a new mechanism of prevention of
coronary heart disease by
statins: they not only lowered
cholesterol level as previously reported, but also contribute directly to plaque stabilization. Among many
statins recently marketed, some act directly onto the blood vessel wall to stabilize plaques already formed (so-called vascular
statins), while
statins are originally classified as chemical or non-chemical. At the same time, reports on pleiotropic activities of
statins, including improvement of
osteoporosis, have accumulated to suggest an extended role of
statins, not merely as a
hypolipidemic agent but also possibly an anti-arteriosclerotic/anti-aging
drug. This article reviews the direct action of
statins on the blood vessel wall, with reference to classification of
statins based on difference in action on the blood vessel wall (hepatic
statins vs. vascular
statins).