| Thrombosis is a key feature of the initiation and progression of atherosclerosis and its clinical squeal. Acute thrombosis can lead to arterial occlusion and consequently provoke myocardial infarction, unstable angina and sudden death. Tissue factor (TF) is a 263-residue small transmembrane glycoprotein. After binding of TF to factor â…¦, the complex proteolytically activates factor â…© to factor â…© a, and factor â…¨ to factor â…¨a, leading to thrombin generation followed by fibrin formation, platelet activation, and thrombosis. Recently, studies have shown increased of TF in atherosclerotic plaque and an important contribution of TF in the thrombogenecity of plaque. Tissue factor pathway inhibitor (TFPI), a glycoprotein with three Kunitz-type domains, is the primary inhibitor of TF-mediated coagulation. TFPI directly inhibits factor X a and blocks thr procoagulant activity of the TF/Fâ…¦a complex by forming a quaternary TF/Fâ…¦a/â…©a/TFPI complex. TFPI is also enhanced in atherosclerotic vessels where it modulates TF activity.Statins, 3-hydrooxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, are used widly for the treatment of hypercholesterolemia. They inhibit HMG-CoA reductase competitively, reduce LDL levels more than other cholesterol-lowering drugs. Several clinical trials in patients with and without ischemic heart disease and with and without hypercholesterolemia have demonstrated consistently that statins reduce the relative risk of major coronary events by ~-30% and produce a greater absolute benefit in patients with higher baseline risk. Angiographic trials have demonstrated clinical improvement with statins that by far exceed changes in the size of atherosclerotic lesions. These data support evidence that statins have beneficial effects beyond cholesterol lowering. Theses effects include protecting endothelial function, anti-inflammation, plaque architecture and stability.
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