Clinical relevance of statins: instituting treatment early in acute coronary syndrome patients

The efficacy of statins in lowering the total and low-density lipoprotein c holesterol and reducing the risk of cardiac events is now well established. The secondary prevention studies started treatment several months after th e acute event. However, the greatest risk of recurrence is shortly after th e index event. Recent evidence from small-scale clinical trials shows that standard doses of statins can be both safe and effective when given early a fter an acute coronary event, including early after thrombolytic therapy fo r myocardial infarction. Angiographic studies have shown beneficial effects of pravastatin on coronary stenosis when initiated after a coronary event. While none of these studies have been powered to demonstrate an effect on outcome, each has shown a reduction in major cardiovascular events. Two lar ge observational studies have shown a reduction in 6- and 12-month risk-adj usted mortality among post-MI patients treated early with statins. Large-sc ale trials of all statins are now in progress to evaluate further the effic acy of early initiation of statin therapy in acute coronary syndromes. The largest of these is the Australian Pravastatin Acute Coronary Treatment (PA CT) study, which will compare early outcomes in patients treated with prava statin versus placebo prescribed within the first 24 h of an acute coronary event. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.