Statins: What is Beyond Hyperlipidemia?-Juniper Publishers
JUNIPER PUBLISHERS-OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY
Statins are the most commonly used lipid lowering
drugs [1]. Recent experimental evidence underscores additional
cholesterol independent or pleiotropic effects, contributing to
prevention and inhibition of atherosclerosis. These vascular pleiotropic
effects include amelioration of endothelial function, the inflammatory
process retardation, the thrombus formation blockage, increase of plaque
stability and decreasing oxidative stress [2]. Thus, currently statins
are believed to be as one of the most powerful drugs for the treatment
of vascular disease [3,4]. The treatment of endothelial dysfunction in
chronic cardiovascular diseases is already evidenced.
Keeping in mind the uniformity of the vascular system
physiologically and pathophysiologically, and that it plays a key role
in age-related macular degeneration (AMD), endothelial dysfunction
should be treated [5,6]. Age-related macular degeneration is a
progressive late onset disease affecting central vision, representing
the leading cause of irreversible blindness among older adults,
affecting one in three people aged 75 or older, and with the aging
population the problem is increasing [7,8].
The estimated number of patients suffered from
age-related macular degeneration will increase by 50% by the year 2020
[9]. At present effective treatment for AMD or for arresting its
progression in its earliest phases does not exist. There is a growing
body of epidemiologic, genetic, pathological evidence suggesting a
possible link between risk factors for cardiovascular disease and
age-related macular degeneration, thus highlighting the rationale behind
statins use.
Statins decrease serum lipid levels, and accumulation
of lipids in the Bruch membrane and drusen, which is a key
pathophysiologic pathway for AMD development [10]. Another mechanisms of
action for statins in AMD are oxidative damage and inflammation
diminishing [10,11]. At the same time choroidal neovascular membranes
associated with AMD include macrophages [12], which may respond to
statins. The association between the use of statins and age-related
macular degeneration has been evaluated in many clinical studies;
however the results have been contradictory [13]. The likely explanation
is an absence of universal approach: for eligibility criteria including
types of AMD, type of statin, dosage, duration of treatment. The latest
encouraging research conducted by Varvas et al. [14] for the first time
evidenced the efficacy of high dose atorvastatin therapy in AMD
patients with high-risk features for progression presented by regress of
druses and corresponding increase of visual acuity. Taken into account
that not all statins are equally effective, the challenge for future
research will be to determine the best type and dosage of statins and to
discover a treatment algorhytm. Currently available findings suggest
that cardiovascular diseases and AMD share similarities in their
pathogenesis, highlighting an importance of cardiovascular disease risk
factors management intended also simultaneously to lower AMD morbidity
and improve the quality of life of aging population.
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