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The Cholesterol and Statins Relationship with the Acute Coronary Syndrome: A Review

Humberto SM and Mariana SB

Introduction: Atherosclerosis is one of the major risk factors for the development of coronary artery disease (CAD) and thus acute coronary syndrome (ACS). The contribution of lipid profile to these conditions justified the existence of 200 million people in the world medicated with statins. However, scientific research shows that although statins are effective in lowering cholesterol levels, the relation between this lowering with morbidity and mortality reduction associated with cardiovascular disease (CVD) has been questioned. This review’s objective to find what has been published in order to try and answer two questions: 1. Is cholesterol the main risk factor for the development of ACS? 2. Will statins be a treatment with a significant impact in reducing the morbidity and mortality of ACS? Methods: A bibliographic search was conducted in the PubMed and Google Scholars databases of relevant scientific articles between 2014 and 2018 in the English language. Results: The efficacy of statins as lipid-lowering drugs is undeniable, but their impact on the morbidity and mortality of ACS is dubious. Criticism emerges from investigations as JUPITER, AFCAPS/TEXCAPS, PROVE-IT-TIMI-22 and TNT studies, some of them sponsored by the pharmaceutical industry. New theories on the pathogenesis of ACS have been delineated as the contribution of inflammatory mechanisms in the process of atherogenesis. Discussion: Cost-effectiveness, statin effectiveness, and other investigations of ACS contributors should be considered, such as inflammation and insulin resistance theory. Statins also have an anti-inflammatory effect (pleiotropic effect) and therefore studies are being conducted to determine whether the reduction of inflammation will be as effective in reducing adverse CV events regardless of statinsproven hypolipidaemia. Furthermore, insulin resistance may play a major role in this atherogenic inflammatory process. Conclusion: A complete and combined treatment is required not only for dyslipidemia but also for insulin resistance, never forgetting the changes in the dietary pattern.