The role of statins in acute coronary syndromes: managing the unmet need.

Coronary heart disease is the major cause of death in the industrialised world. As the prevalence increases with advancing age, coronary heart disease will be a growing problem as the average age of the population increases. The cost of treatment following an acute coronary syndrome is considerable and there is a substantial risk of further episodes. However, there is much evidence that the disease is a dynamic and reversible process and further episodes are preventable. Numerous trials have shown the efficacy of statins in coronary heart disease. The most recent studies have shown efficacy in secondary prevention when statin therapy was started early (hours/days) after an acute episode. Although guidelines recommend that statin therapy should be initiated following an acute coronary syndrome, prescription rates seem to be static at around 40%. A number of measures need to be taken to improve the situation. Firstly, each hospital and coronary care unit should implement a clearly defined protocol delineating patient management following hospital admission. Provision of comprehensive discharge information should be a key feature of this communication. Secondly, regular audit of prescribing habits is essential to assess the situation. Finally, patient adherence to their regimen should be improved by collaborative involvement of doctor and patient in planning and implementing the treatment regimen.