Amit Kumar, Christopher P. Cannon.

The current role of statins in acute coronary syndrome

Statins have long been known to be effective for primary and secondary prevention of coronary heart disease (CHD), and reduction of low density lipoprotein-cholesterol (LDC-C) levels over time was thought to be the mechanism by which statins exerted their clinical effectiveness. Data from recent large randomized trials have established the efficacy and safety of intensive statin therapy started early after ACS and have provided new insights into the mechanism of action of statins. While the early benefits appear to be related more to dose dependent LDL-C independent “pleiotropic” effects and reduction in C-reactive protein (CRP), which is an inflammatory biomarker, the long-term benefits are related to reductions in both LDL-C and CRP. The current state of evidence, based upon key trials of statins in ACS, supports a central role for statin therapy, in particular intensive statin therapy, in the management of patients with ACS.