title: Update on the efficacy of statin treatment in acute coronary syndromes.
abstract: BACKGROUND
  The natural history of atherosclerosis might involve coronary plaque rupture/erosion, thrombus formation and vessel lumen occlusion, clinically recognized as acute coronary syndrome (ACS). International guidelines strongly recommend early statin administration in patients admitted for ACS. In addition to lowering circulating levels of low-density lipoprotein cholesterol (LDL-c), statin treatment was shown to promote plaque stabilization or regression in several ways, including reduction in necrotic lipid core, anti-inflammatory effects and improvement in endothelial function. The aim of this review is to summarize clinical evidence on the role of statins in secondary prevention of ACS.
  
  
  METHODS
  This narrative review is based on the material found on medline and pubmed up to August 2013. We looked for the terms 'statin, acute coronary syndromes' in combination with 'atherosclerosis, acute myocardial infarction, pathophysiology'.
  
  
  RESULTS
  This review article emphasizes the relevance of the timing of statin administration to improve the outcomes after ACS. Early and continuous statin administration has emerged as key features to prevent adverse events, especially in patients admitted for ACS undergoing percutaneous coronary intervention. Clinical trials matching the improved clinical outcome with the imaging of atherosclerotic plaque stabilization/regression, further supporting the effectiveness of statin therapy. However, the achievement of these goals requires high dose of statins, thus increasing the risk of adverse events.
  
  
  CONCLUSIONS
  Although clinical trials and meta-analyses have provided conflicting results, it is likely that in clinical practice, the rate of adverse events is higher, so that many concerns still remain about a statin high-dose approach in ACS patients.
authors.affiliation: Clinic of Cardiovascular Diseases, Department of Internal Medicine, University of Genoa School of Medicine, IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy.
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Rosa
authors.forename: Federico
authors.initials: F
authors.lastname: Carbone
authors.forename: Antonello
authors.initials: A
authors.lastname: Parodi
authors.forename: Elena A
authors.initials: EA
authors.lastname: Massimelli
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunelli
authors.forename: François
authors.initials: F
authors.lastname: Mach
authors.forename: Nicola
authors.initials: N
authors.lastname: Vuilleumier
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Montecucco
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000473:pathology; D004812:Epidemiologic Methods; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D058226:Plaque, Atherosclerotic / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute coronary syndromes; atherosclerosis; intravascular ultrasound; percutaneous coronary intervention; statins