Statin therapy and the management of acute coronary syndromes.
The pathophysiology of acute coronary syndromes is related to erosion or rupture of vulnerable plaque leading to intracoronary thrombosis as a result of activation of the coagulation cascade and platelet aggregation. Potential benefit of hypolipidemic 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibition may be related to the pleiotropic effects such as endothelial function improvement, stabilization of the plaque in relation to reduced macrophage activity and smooth muscle cell proliferation, as well as other anti-inflammatory effects that have been demonstrated in animal models. With the publication of the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) study, early initiation of statin therapy within 24 to 96 h has been recognized as an important addition to the therapeutic armamentarium in the management of patients with acute coronary syndromes.
Langer
Anatoly
A
Canadian Heart Research Centre and St Michael's Hospital, University of Toronto, Toronto, Canada. langera@chrc.net
Constance
Christian
C
Fodor
Jiri G
JG
Frohlich
Jiri J
JJ
Grégoire
Jean
J
Lau
David C W
DC
Leiter
Lawrence A
LA
Mancini
G B John
GB
Marr
David
D
McPherson
Ruth
R
O'Neill
Blair J
BJ
Rabkin
Simon W
SW
D000208:Acute Disease; D001777:Blood Coagulation / Q000187:drug effects; D003327:Coronary Disease / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology; D019468:Disease Management; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D010974:Platelet Aggregation / Q000187:drug effects; D013577:Syndrome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors