Statin loading for acute coronary syndromes.
OBJECTIVE
This review discusses the role of statin therapy in patients with acute coronary syndromes. These drugs modulate endothelial function and stabilize atherosclerotic plaque by inhibiting oxidative stress and inflammation and may provide a relevant clinical benefit in unstable patients.


RESULTS
Conflicting data derive from randomized trials about early statin therapy in medically treated patients with acute coronary syndromes. Results of the ARMYDA studies demonstrate a clear benefit of statin pretreatment in patients with both stable and unstable syndromes undergoing percutaneous coronary revascularization. In the ARMYDA RECAPTURE, even an acute reload with high-dose atorvastatin in patients on top of chronic statin use was associated with a significant reduction of 30-day major adverse cardiac events, especially in those patients who presented with acute coronary syndromes.


CONCLUSIONS
All this evidence strongly supports an 'upstream' administration of high-dose statins in patients with acute coronary syndromes treated with an early invasive strategy.
Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy.
Annunziata
A
Nusca
Rosetta
R
Melfi
Giuseppe
G
Patti
Germano
G
Di Sciascio
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D015415:Biomarkers; D002097:C-Reactive Protein; D016207:Cytokines / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects*; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007249:Inflammation / Q000517:prevention & control; D018384:Oxidative Stress / Q000187:drug effects; D011300:Preoperative Care; D011758:Pyrroles / Q000627:therapeutic use; D013997:Time Factors
D000924:Anticholesteremic Agents; D015415:Biomarkers; D016207:Cytokines; D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D002097:C-Reactive Protein; D000069059:Atorvastatin