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(Chest. 2005;128:3641-3651.)
© 2005 American College of Chest Physicians

In-Hospital Initiation of Statin Therapy in Acute Coronary Syndromes*

Maximizing the Early and Long-term Benefits

Gregg C. Fonarow, MD

* From the Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA.

Correspondence to: Gregg C. Fonarow, MD, Ahmanson-UCLA Cardiomyopathy Center, Division of Cardiology, UCLA School of Medicine, 47–123 CHS, 10833 LeConte Ave, Los Angeles, CA 90095-1679; e-mail: gfonarow{at}mednet.ucla.edu

Patients with acute coronary syndrome (ACS) are at high risk for recurrent coronary events, sudden death, and all-cause mortality. Conventional revascularization therapies reduce the risk of further ischemia but do not affect the underlying atherosclerotic disease. Statins have a proven record in the secondary prevention of coronary heart disease. Furthermore, statins have been shown to exert varying degrees of pleiotropic effects, which may stabilize vulnerable atherosclerotic plaques. A compelling body of evidence from randomized controlled trials demonstrates that high-dose, potent statin therapy initiated immediately after an acute coronary event can significantly reduce early as well as longer-term morbidity and mortality. Furthermore, high-dose, potent statin therapy displays a reasonable safety profile. National guidelines now recommend that in patients with ACS, statin therapy should be initiated in hospital prior to discharge, irrespective of baseline low-density lipoprotein cholesterol levels, to improve clinical outcomes. Every effort should be made to ensure all eligible patients with ACS are initiated and maintained on statin therapy.

Key Words: acute coronary syndrome • atherothrombosis • high-sensitivity C-reactive protein • low-density lipoprotein cholesterol • statin






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