Acute Coronary Syndrome and Early Statin Therapy: What Is the Evidence?

In patients with stable ischemic heart disease, lipid-lowering treatment with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) markedly reduces long-term morbidity and mortality. In trials where statin therapy has been initiated as secondary prevention after an acute coronary syndrome (ACS), treatment has been initiated 3–6 months after the event. In the unstable clinical state after an ACS, patients experience a high rate of serious complications including death and myocardial infarction. The incidence of serious complications declines after 1 month and then gradually diminishes. It has not been determined whether initiation of statin therapy soon after an ACS can reduce the occurrence of early coronary events. Statins have effects on the vessel wall beyond a lipid-lowering effect, which may partly account for the benefit of statin therapy. It is not yet clarified if these mechanisms are associated with a prognostic effect soon after an ACS.