Statins are lipid-lowering agents block cholesterol
biosynthesis in the liver as they prevent the formation of cholesterol
precursor mevalonate and inhibit 3-hydroxy-3-methyl-glutaryl-coenzyme A
(HMG-CoA) 1, 2. Through the last three decades, an extensive research in
literature focused on pleiotropic protective effects of statins in patients
with cardiovascular disease (CVD) independently of LDL-C lowering effect 3,
4.

Statins can exert their favorable pleiotropic effects
through increasing expression of atheroprotective genes, inhibition of
pro-inflammatory mediators, endothelial protective effects, enhancing the
stability of atherosclerotic plaques, inhibiting vascular smooth muscle
proliferation, decreasing platelet aggregation, increasing nitric oxide
bioavailability, reducing adhesion molecules, decreasing circulating biomarkers
of oxidative stress and inflammation, inhibiting thrombogenic response 5, 6.

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In clinical practice, statins have a potential protective
role in primary and secondary prevention of all-cause mortality and major
coronary events compared to control 7. For primary prevention of mortality
and atherosclerotic cardiovascular events, statin therapy is one of the most
effective interventions and risk-factor modifications 8. In high-risk
patients with established coronary artery disease (CAD), recommendations of
statins for secondary prevention differ between guidelines. Many guidelines
recommend LCL-C goal of <70 mg/dL 9, 10, while the use of high- Attainment of low density lipoprotein-cholesterol (LDL-C) goal of 70 mg/dl is widely recommended 9,10, however, the recommendations on cholesterol management by American College of Cardiology/American Heart Association (ACC/AHA) guideline indicate the use of high-intensity statins for secondary prevention in acute coronary syndrome (ACS) with repeated measurement of lipid profiles 11. In the last years, a debate remains about statin therapy in patients with CAD regarding the clinical uses of statins, patient eligibility for therapy, role of high-intensity statins 12, 13, benefits of combination with other lipid-lowering agents, effects on outcome after coronary artery revascularization 15, and residual risk of secondary coronary artery events 16. Therefore, the aim of this review is to highlight targets and debates of research concerning the role of statin therapy in patients with CAD.