Published online before print August 1, 2002, doi: 10.1161/01.ATV.0000032033.39301.6A
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© 2002 American Heart Association, Inc.
Brief Reviews |
Statin Therapy in Acute Coronary Syndromes
Mechanistic Insight Into Clinical Benefit
From the Dyslipoproteinemia and Atherosclerosis Research Unit (A.C.S., M.J.C.), National Institute for Health and Medical Research U551, Hôpital de la Pitié-Salpetriere, Paris, France, and the Heart Institute (InCor) (A.C.S.), University of São Paulo Medicine School, São Paulo, Brazil.
Correspondence to Dr Andrei C. Sposito, INSERM U551, Hôpital de la Pitié-Salpetrière, 83, Bd de l’Hôpital, F-75651 Paris Cedex 13, France. E-mail sposito{at}chups.jussieu.fr
Randomized trials have established that statin treatment reduces coronary events in primary prevention and in patients with stable coronary artery disease. In unstable coronary artery disease, however, the pathophysiological background is distinct, and the potential benefits of statin therapy have not been evaluated until recently. Data from animal models and clinical studies indicate that statin treatment can influence a spectrum of molecular and cellular mechanisms that are intimately related to the pathogenesis of acute coronary syndromes; these include the reduction of circulating levels of atherogenic lipoproteins (very low density lipoprotein, very low density lipoprotein remnants, intermediate density lipoprotein, and low density lipoprotein) and thus of arterial lipid deposition and the attenuation of inflammation, modulation of thrombogenesis and thrombolysis, improvement of endothelial dysfunction, and reduction of ischemia/reperfusion injury. Indeed, findings from prospective and observational studies have demonstrated that statin treatment significantly improves clinical outcome after acute coronary syndromes. Therefore, early initiation of statin therapy after an acute coronary event not only enhances adherence to treatment but also preempts the occurrence of new events. In this review, we discuss recent important developments in our knowledge of the clinical evidence of the beneficial effects of early statin therapy in acute coronary syndromes and the biological mechanisms that underlie them.
Key Words: acute coronary syndromes • statins • secondary prevention
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