Lipid management after acute coronary syndrome.
OBJECTIVE
Despite advances in medical therapy and percutaneous revascularization, patients with acute coronary syndrome face a high risk of early, recurrent cardiovascular events. Interventions targeting atherogenic lipoproteins may favorably modify this risk.


RESULTS
Two randomized clinical trials, MIRACL and PROVE-IT, demonstrated efficacy of early, intensive statin therapy after acute coronary syndrome. Recent observational and meta-analyses corroborate the findings of these trials. The benefit of intensive statin treatment appears to apply broadly to elderly as well as younger patients, and to patients with or without diabetes or metabolic syndrome. Randomized trials demonstrating the efficacy of early, intensive statin treatment after acute coronary syndrome employed fixed statin dosages, and there does not appear to be an initial or achieved LDL-cholesterol level below which benefit is absent. As such, broad application of intensive statin therapy after acute coronary syndrome may be preferable to titration of statin dose to achieve specific LDL goals. Low HDL-cholesterol predicts risk after acute coronary syndrome; therefore, pharmacologic interventions to raise HDL concentration or mimic its function may help reduce that risk.


CONCLUSIONS
Early, intensive statin therapy is safe and effective after acute coronary syndrome. Future research will determine whether drugs that raise or mimic HDL-cholesterol are effective adjuncts to statin therapy.
Schwartz
Gregory G
GG
VA Medical Center and University of Colorado Health Sciences Center, Denver, Colorado 80220, USA. gregory.schwartz@va.gov
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism*; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002784:Cholesterol / Q000378:metabolism*; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D000924:Anticholesteremic Agents; D002784:Cholesterol