Editorial Commentary: Statins and acute coronary syndromes

Abstract

In this issue of the journal, the authors review the available data regarding the beneficial effects of statins on the prognosis of patients with acute coronary event syndromes and particularly of patients with myocardial infarction manifested electrocardiographically as ST segment myocardial infarction [1]. Throughout this article, the authors make the comment that transmural myocardial infarction presenting with ST segment elevation constitutes a bigger hazard than the subendocardial infarction seen in myocardial infarction patients presenting without ST segment elevation. I do not necessarily agree with that since data are available in 1 year indicating that both have a similar mortality. I do not think we should give the impression that a myocardial infarction, no matter what you call it, is good for you and that a myocardial infarction not associated with ST segment elevation on the electrocardiogram is benign. In the section on “statin administration in patients with ST elevation associated with a myocardial infarction,” the authors outline their thoughts about how statins work to alter many of the biological factors that stimulate the vascular endothelium by their pleiotropic action. In this section of the article, the authors emphasize the pleiotropic action of statins, including the reduction of platelet stimulation, and make the point that statins are plaque stabilizers. I think all agree that statins have a pleiotropic effect, and I think everything referred to is correct, but do not think there is anything new in that section, and it is difficult to remember all that was said. Although the pleiotropic effects of statins are certainly present, however, they are not measured clinically in the individual patient and thus are not very useful to the physician taking care of acute coronary syndrome patients. Only, lipid levels, and outcome are measured.