[Should we begin with statin therapy in acute coronary syndrome?]

Acute coronary syndrome (ACS) constitutes a unique syndrome with a distinct pathophysiology: rupture of the fibrous cap of unstable atherosclerotic plaques in coronary arteries resulting in subsequent platelet deposition and a thrombus formation that completely or partially occludes the artery. Remarkable therapeutic advances in the treatment of ACS have been made during the past decade with antiplatelet and antithrombotic therapy. However, these therapies alone do not appear to completely stabilize the unstable plaque. Results from several clinical trials suggest that early administration of a statin following an ACS may reduce both short-term and longterm adverse outcomes such as subsequent cardiovascular mortality, myocardial infarction and revascularization. The potential mechanisms of benefit include improvements in endothelial function and vasomotion, reduction of platelet aggregability and thrombus formation, fibrinolytic and antioxidant activity as well as reduction of inflammation within plaques, reducing matrix degradation due to reduction of macrophage metalloproteinase production and increasing collagen content. Based upon the current knowledge, it might be concluded that patients hospitalized for ACS should be given a statin and the treatment should be initiated as soon as possible.