Unstable angina--a definitive role for statins in secondary prevention

Unstable angina is a life-threatening disease. The overall incidence is estimated to be between 0.1 and 0.2% and, of those admitted to hospital, up to 5% die within the first six weeks. With such a high prevalence and poor prognosis, there is still a clear need for improved secondary preventive treatment. Several landmark statin trials (CARE, LIPID and 4-S) have now shown the benefits of lowering cholesterol, starting months after an acute coronary event, and several smaller studies (such as L-CAD, PTT and RECIFE) have demonstrated the clinical benefits of very early statin treatment. Recent research suggests the underlying cause of the disease, atherosclerosis, is a dynamic and potentially reversible process. Statins may tip this balance in favour of resolution by cholesterol lowering and through pleiotropic effects independent of lipid lowering. Pravastatin, when given very early in the clinical course, has already been shown to improve both plaque stability and endothelial function, as well as clinical outcome, suggesting it as the drug of choice in early secondary prevention.