The chapter discusses the pleiotropic effects of statins, which have revolutionized the management of patients at risk for ischemic events due to dyslipidemia. Statin therapy has been shown to reduce cardiovascular mortality and total mortality across various patient subgroups. The mechanisms underlying the benefits of statins are controversial, with the causal theory attributing the benefits to lipid lowering, while the noncausal theory emphasizes the pleiotropic effects of statins, such as improved endothelial function, reduced inflammation, and altered coagulation and plaque vulnerability. The introduction highlights the significant decrease in age-adjusted death rates from coronary atherosclerosis over the past two decades, attributed to advancements in risk factor modification and revascularization techniques. Statins have become a key tool in lipid management, reducing LDL cholesterol by up to 60%. However, the mechanisms of their benefits remain a subject of debate. The section on endothelial function explains how statins can improve endothelial function by activating endothelial nitric oxide synthase (eNOS), which is independent of cholesterol-lowering effects. Studies using animal models and clinical trials have shown that statins can reduce circulating levels of vasoconstrictors like endothelin and angiotensin, increase nitric oxide production, and improve vascular tone. These effects are associated with reduced atherosclerotic area and improved lesion composition, suggesting that statins may play a crucial role in preventing and treating atherosclerosis.The chapter discusses the pleiotropic effects of statins, which have revolutionized the management of patients at risk for ischemic events due to dyslipidemia. Statin therapy has been shown to reduce cardiovascular mortality and total mortality across various patient subgroups. The mechanisms underlying the benefits of statins are controversial, with the causal theory attributing the benefits to lipid lowering, while the noncausal theory emphasizes the pleiotropic effects of statins, such as improved endothelial function, reduced inflammation, and altered coagulation and plaque vulnerability. The introduction highlights the significant decrease in age-adjusted death rates from coronary atherosclerosis over the past two decades, attributed to advancements in risk factor modification and revascularization techniques. Statins have become a key tool in lipid management, reducing LDL cholesterol by up to 60%. However, the mechanisms of their benefits remain a subject of debate. The section on endothelial function explains how statins can improve endothelial function by activating endothelial nitric oxide synthase (eNOS), which is independent of cholesterol-lowering effects. Studies using animal models and clinical trials have shown that statins can reduce circulating levels of vasoconstrictors like endothelin and angiotensin, increase nitric oxide production, and improve vascular tone. These effects are associated with reduced atherosclerotic area and improved lesion composition, suggesting that statins may play a crucial role in preventing and treating atherosclerosis.