Lipid-lowering therapies in the management of acute coronary syndromes

Despite the significant advances made in the treatment of acute coronary syndromes (ACS) with antiplatelet and antithrombotic therapy, the risk of serious complications remains high, especially in the first few months following an acute coronary event. Although lipid-lowering therapy in patients with significant risk factors (primary prevention) or stable coronary disease (secondary prevention) is known to improve long-term survival, patients with a recent ACS were specifically excluded from the early statin trials. However, the use of lipid-lowering agents (principally statins) during hospitalization or in the period immediately following an acute coronary event has recently been studied. Statin therapy in this setting has been shown to reduce angina, rehospitalization, and mortality. Improved outcomes associated with lipid-lowering therapy in ACS may be mediated through beneficial effects on plaque stabilization, endothelial function, inflammation, and thrombus formation. This paper reviews the evidence supporting the potential benefits and mechanisms of statin therapy in the management of ACS. Clinical guidelines to achieve optimal lipid management are also discussed.