Elsevier

The Lancet

Volume 348, Issue 9034, 19 October 1996, Pages 1079-1082
The Lancet

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Statins do more than just lower cholesterol

https://doi.org/10.1016/S0140-6736(96)05190-2Get rights and content

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Changes in the vessel wall

The process of plaque fissuring, which results in thrombosis, triggers most acute coronary events. Most lesions prone to fissuring and rupture have a large core of lipid-laden macrophages and a thin fibrous cap underlying the endothelium. Although these vulnerable lesions account for 10–20% of all lesions, they are responsible for 80–90% of acute clinical events.5 The reduction in clinical events secondary to lipid lowering has been conventionally attributed to the selective depletion of both

Blood flow, vasomotor tone, and endothelial function

The endothelium is involved in the regulation of vasomotor tone, inhibition of platelet activity, inhibition of thrombosis, and promotion of fibrinolysis. Endotheliumderived relaxing factor (EDRF) is a prominent modulator of normal endothelial function (figure 2). EDRF production is stimulated by various factors including platelet activation, shear stress, and concentrations of thrombin, serotonin, and catecholamines. The importance of EDRF and changes in EDRF production in atherosclerosis have

Changes in the constituents of blood

Platelets contribute to both atherosclerosis and thrombosis and play a central role in acute coronary syndromes (figure 2). Hypercholesterolaemia is associated with hypercoagulability as well as enhanced platelet reactivity at sites of acute vascular damage.23 Patients with hypercholesterolaemia have higher resting levels of malondialdehyde, thromboxane B2, and β-thromboglobulin, which suggests that high blood cholesterol induces lipid peroxidation and platelet activation.24 The following

Conclusion

Although the components of Virchow's triad are far less discrete than originally envisaged, the triad is still a conceptually useful way to explore the vascular milieu with respect to both thrombosis and atherosclerosis. The complex interactions between endothelium, platelets, and macrophages cannot be viewed separately. The production of a myriad of factors by platelets and macrophages on one hand, and by the endothelium on the other, makes any evaluation of the in-vivo effects of statin

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