Statins and the acute coronary syndrome: 'the early bird catches the worm'.
The early period following an acute coronary syndrome (ACS) is characterised by atherosclerotic plaque destabilisation and a pro-coagulant state, and is when patients are at highest risk for recurrent cardiovascular events and mortality. Statins decrease thrombus formation and increase fibrinolysis, inhibit platelet reactivity and aggregation, improve endothelial function in patients with coronary artery disease and have a major role in plaque stabilisation. Several studies showed that initiation of early statin therapy in these settings may have beneficial effects. This review summarises the current data on statins in the setting of ACSs. Known and other possible mechanisms of action are described. The pathophysiological mechanisms, histological features and biochemical characteristics of ACS are different than those with stable coronary disease, thereby suggesting that the mechanisms whereby statins exert their benefits in ACS may be distinct from those for stable CHD. Initiation of the therapy during hospitalisation rather than at the time of hospital discharge may provide protection against early recurrent cardiovascular events and also improve patients' compliance.
Nair
P
P
Department of Cardiology, Rambam Medical Center, B. Rappaport, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Roguin
A
A
D002097:C-Reactive Protein / Q000378:metabolism; D008078:Cholesterol, LDL / Q000097:blood; D002986:Clinical Trials as Topic; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004730:Endothelium, Vascular / Q000503:physiopathology; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D017202:Myocardial Ischemia / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012307:Risk Factors; D013577:Syndrome; D013928:Thromboxane A2 / Q000037:antagonists & inhibitors
D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D013928:Thromboxane A2; D002097:C-Reactive Protein