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Professor Emeritus, School of Pharmacy, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA; President and CEO, National Clinical Research, 2809 Emerywood Parkway, Suite 140, Richmond, VA 23294-3740, FAX 804/672-3369, E-mail jmckenney{at}ncrinc.net
Reprints: James M McKenney PharmD
OBJECTIVE: To review the current evidence for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins) in nontraditional lipid-related applications, including acute coronary syndromes, peripheral arterial disease, stroke, and renal disease, and to describe ongoing trials evaluating the role of statins in these conditions.
DATA SOURCES: Clinical literature was identified by a
MEDLINE search (1990–November 2002) using 
1 of the following search
terms: acute coronary syndrome(s), angina pectoris, atherosclerosis,
atorvastatin, clinical trials, diabetes mellitus, end-stage renal disease,
fluvastatin, lovastatin, myocardial infarction, peripheral arterial disease,
pravastatin, simvastatin, statins, and stroke. Treatment guidelines issued by
professional and governmental organizations, such as the American Diabetes
Association, American Heart Association, National Cholesterol Education
Program, National Kidney Foundation, and National Stroke Foundation, were
reviewed.
STUDY SELECTION AND DATA EXTRACTION: Articles identified from the data sources were included if they pertained to the conditions described in the objectives and provided unique information concerning use of statins.
DATA SYNTHESIS: Substantial evidence exists for the use of statins in acute coronary syndromes. Meta-analyses of data from major clinical trials indicate that statins prevent first and recurrent stroke, and large-scale trials are underway to evaluate the efficacy of statins in this setting. Accumulating evidence suggests that statins may be beneficial in reducing the morbidity and mortality associated with peripheral arterial disease and end-stage renal disease, and results from ongoing trials may confirm these benefits. Statins may also have a future role in amelioration of other conditions associated with atherosclerosis, such as diabetes mellitus.
CONCLUSIONS: A large body of evidence supports the evaluation of statins in clinical settings beyond primary and secondary prevention of morbidity and mortality associated with coronary atherosclerosis.
Key Words: acute coronary syndromes, peripheral arterial disease, renal disease, statins, stroke
Published Online, June 10, 2003. www.theannals.com, DOI 10.1345/aph.1C499
THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE
UNIVERSAL PROGRAM NUMBER: 407-000-03-018-H01
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