Disfuncţia endotelială şi efectele pleiotrope ale statinelor

Abstract

Background: Growing clinic evidences indicate the role of endothelial dysfunction in pathogenesis of cardiovascular disorders, an evidence proven by use of many specific and reliable markers. More than that, endothelial dysfunction is viewed and promoted as an important therapeutic target in which regard statins occupy a special position due to their pleiotropic effects. This article is aimed at the evaluation of most important predictors of endothelial dysfunction and its mechanisms concerning coronary remodeling as well as the latest data of statin efficiency in patients with coronary lesion. Endothelial dysfunction facilitates smooth vascular cell migration to neointima due to activation of metalloproteinases and extracellular matrix degradation. It also leads to activation of oxidative stress and systemic inflammation resulting in oxi-LDL and mononuclear cells accumulation in neointimal zone contributing to atheromatous plaque destabilization and prothrombotic state. Endothelial dysfunction is a crucial factor of major cardiovascular events’ (MACE) risk after angioplasty. Most important predictors of endothelial dysfunction are: decreased nitric oxide, endothelial progenitor cells, tetrahydrobiopterin, flow mediated brachial artery dilation, and increased intima-media thickness and C reactive protein. Statins demonstrated in many randomized trials beneficial effect on ischemic heart disease and coronary remodeling. Statins, especially in high doze, improve endothelial markers, reduce the rate of MACE after angioplasty inclusive of in-stent restenosis, and mitigate the oxidative stress and inflammatory response. In the recent trial (IBIS-4, 2015) statins showed a capacity of atherosclerotic plaque regression in patient with ST-segment of elevation myocardial infarction assayed by intravascular ultrasonography. Conclusions: The endothelial dysfunction markers use can optimize the cardiovascular diagnostics and prognostics, and statins improve coronary remodeling