Changing the practice of cardiovascular medicine

Five large randomized trials of statins in primary and secondary prevention show the benefits of lipid-modifying therapy on cardiac morbidity and mortality. Evidence is beginning to accumulate showing that early and aggressive treatment of patients with acute coronary syndromes (acute myocardial infarction or unstable angina) can result in reduced mortality and morbidity and imparts a variety of mechanistic benefits. Nevertheless, recent surveys of coronary heart disease prevention in Europe and the US indicate that current evidence-based management of risk factors such as hypercholesterolemia is not uniformly employed. In fact, in Europe, only about a third of patients discharged from the hospital after an acute coronary syndrome are receiving prescriptions for statins. In US, more than a fourth of adults are eligible for treatment according to national guidelines but two thirds of them do not receive it. Among those treated, a considerable number do not reach their target levels. Therefore, strategies are needed to improve prescribing patterns among physicians and compliance among patients. It is essential that clinicians be aware of the evidence base supporting early and aggressive treatment of patients with acute coronary syndromes and that this is communicated to all clinicians involved in their care of patients with acute coronary syndromes.