Updated evidence on early statin therapy for acute coronary syndromes: Meta-analysis of 18 randomized trials involving over 14,000 patients

Lipoproteins as Biomarkers and Therapeutic Targets in the Setting of Acute Coronary Syndrome

“…In PROVE-IT-TIMI 22, ratios of total cholesterol/ HDL-C and apolipoprotein B/A-I (apoB/A-I) and non-HDL-C provided similar information on 2-year event rates as LDL-C. 6 Several statin trials have enrolled patients within a window after presentation with ACS. A meta-analysis of 18 randomized placebo-controlled clinical trials involving 14 303 patients with statin therapy initiated within 14 days of an ACS event 7 revealed a favorable trend (risk ratio, 0.93) but not a statistically significant reduction in hard end points of death, MI, and stroke at 1 or 4 months with early statin therapy compared with placebo on top of standard of care. However, at 4 months after ACS, there was a significant reduction in the occurrence of unstable angina and rehospitalization in patients receiving early statin therapy.…”

Effectiveness of statin therapy for elderly acute myocardial infarction patients with normal levels of low-density lipoprotein cholesterol

“…In a series of 633 stroke pts with hypertension, review of their clinical records and of an extensive 13 year 12 lead ECG data base we found, largely serendipitously, 34.9% to have evidence of AF [3]. More recently in 529 elderly stroke pts (N74 years), using a similar clinical and ECG data base, we found 45.4% to have AF [4]. Because the recording of ECGs in these pts was not prospective and random, and diagnosis of AF was serendipitous and largely fortuitous, we felt that intermittent AF might have been missed in many of these stroke pts.…”

“…The effectiveness of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin) therapy for patients with coronary artery disease has been extensively evaluated [1][2][3][4][5]. According to current guidelines for secondary prevention, an adequate statin therapy is that which lowers low-density lipoprotein cholesterol (LDL-C) to b100 mg/dL, or b70 mg/dL in the case of very high-risk patients [6].…”

Risk to and resilience of the coronary heart disease patient during surgery

“…Statins' cardioprotective effect stems from their antiinflammatory, antithrombotic effects, improved endothelial function, increased nitric oxide bioavailability and antioxidant properties, facilitating plaque stabilization and regression over a period of months and years [17]. Statins administered early (within 14 days) after acute coronary syndrome reduce cardiovascular events only after 4 months of therapy [18]. Acute administration of statins before percutaneous coronary intervention reduced troponin elevation in RCT and a meta-analysis but did not reduce mortality [19].…”