RESUMO
Statins are well-tolerated, mainstay drugs in cardiovascular risk management. In addition to their cholesterol-lowering properties, statins also have anti-inflammatory, vasculoprotective, and antioxidant effects. They have also been associated in some epidemiologic studies with reduced risk of Alzheimer's disease (AD), and a link between cholesterol and late-onset AD has been documented. Experimental studies in cell culture systems and animal models show that statins have neuroprotective effects that may ameliorate the damage inflicted by stroke and AD. Human studies have garnered compelling evidence that treatment with statins reduces ischemic stroke incidence independent of their lipid-lowering effects. There is also the possibility that statins and extremely low cholesterol levels may increase the risk of intracranial hemorrhage. In this review, we discuss the potential reasons for the effect of statins on stroke and AD, and the multiple mechanisms of action of this class of lipid-lowering drugs.
Assuntos
Anticolesterolemiantes/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Doenças do Sistema Nervoso/tratamento farmacológico , Doença de Alzheimer/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hemorragias Intracranianas/induzido quimicamente , Ensaios Clínicos Controlados Aleatórios como Assunto , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/prevenção & controleRESUMO
Inhibitors of HMG-CoA reductase (statins) are cholesterol-lowering agents that dramatically reduce morbidity and mortality in patients with established cardiovascular disease. In addition, they exhibit pleiotropic effects that operate independently of lipid modification. Statin administration results in greater nitric oxide bioavailability, improved endothelial function, enhanced cerebral blood flow, immune modulation with anti-inflammatory action, decreased platelet aggregation and antioxidant activity. Some or all of these effects may improve outcome or ameliorate symptoms in neurological disorders. This article examines the potential role of statins in treating stroke, Alzheimer's disease, multiple sclerosis and Parkinson's disease. Studies are ongoing in this controversial area, but there are no firm conclusions. The appropriateness of initiating statin therapy for neurological disorders is not established at this time. The exception is stroke, in which recurrence is significantly reduced by statin therapy.