Atherosclerosis with a high incidence of cardiovascular disease is the major health risk and a strong association between atherosclerosis and hypercholesterolemia has been established. Since 1987 pharmacological intervention is based mainly on the inhibition of hepatic cholesterol synthesis using 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA)- reductase inhibitors (statins). Ezetimibe, approved in 2002, is a new therapeutic approach reducing intestinal cholesterol absorption. So far, concomitant therapy using a statin and ezetimibe has proven to be effective and well tolerated. In addition, the clinical relevance of pleiotropic effects of statins has emerged and atherogenic properties of elevated plasma levels of dietary derived plant sterols (e.g. campesterol and sitosterol) are discussed. This review summarizes the effects of statins and ezetimibe, the pleiotropic effects of statins, and the possible role of phytosterols as additional risk factors for vascular disease.
Keywords: hypercholesterolemia, atherosclerosis, ezetimibe, statin, 3-hydroxy-3-methylglutaryl-coenzyme a hmg-coareductase inhibitor, pleiotropic effect, phytosterol
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