Statin therapy is the gold standard in the treatment of
dyslipidemia. Understanding the mechanisms of action of these drugs provides an opportunity to define new therapeutic goals for
pharmacotherapy in patients with atherosclerotic lesions. The present review indicates the existence of previously unknown therapeutic targets for
statins, such as Krüppel-like Factor 2 (KLF-2),
Cystathionine γ
lyase (CSE) and the
microRNA regulating eNOS activity and synthesis; nuclear PXR receptor and EB
transcription factor regulating
Inflammasome NLRP3 activity; the Dickkopf-related
protein 1 (DKK-1), which inhibits the WNT signalling pathway; the
peroxisome proliferator-activated receptor (
PPAR-γ) in vascular smooth muscle cells (VSMCs), which regulates the cell cycle, and the ERK5-Nrf2 pathway, which reduces the level of harmful
advanced glycation end-products (AGE) in VSMCs during diabetic vasculopathy. Importantly, our review includes a number of promising discoveries, specifically those related to the effects of miR-221, miR-222 and miR-27b on the structure, synthesis and activity of eNOS, such as
microRNA-based
therapies, which offer promise in future targeted
therapies. In contrast to numerous experiments confirming the pleiotropic effect of
statins, there is still insufficient evidence on the pleiotropic effect of
ezetimibe, which goes beyond its basic inhibitory effect on intestinal
cholesterol absorption. However, recent studies indicate that this effect is limited to inhibiting macrophage migration, decreasing
VCAM-1 expression and reducing the levels of
reactive oxygen species. Defining new therapeutic goals for
pharmacotherapy in patients with atherosclerotic lesions and ensuring effective treatment of
dyslipidemia and its associated cardiovascular complications requires a thorough understanding of both the mechanisms of action of these drugs and of
atherosclerosis itself.