Optimizing lipid management in patients with acute coronary syndromes.

According to the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), patients with low-density lipoprotein (LDL) cholesterol > or = 130 mg/dL should be discharged on lipid-lowering therapy. When LDL cholesterol levels are between 100 and 129 mg/dL, evaluation of ratios of LDL cholesterol/high-density lipoprotein (HDL) cholesterol or total cholesterol/HDL cholesterol may provide additional insight into a patient's risk status. Patients who were using statin therapy before admission for an acute coronary syndrome should be continued on lipid-lowering therapy. The American College of Cardiology/American Heart Association (ACC/AHA) 2002 guideline update for management of patients with unstable angina and non-ST-segment elevation myocardial infarction recommends statin therapy at discharge as a class I indication, level of evidence A. Furthermore, studies confirm that statin therapy begun early during hospitalization can prevent ischemic events in patients who are treated by an invasive strategy and those who are treated only by a medical strategy. However, studies suggest that patient compliance with a statin regimen after discharge is far from optimal. There are 2 programs available to help ensure that appropriate patients receive and continue taking lipid-lowering therapy. These programs are the Cardiac Hospitalization Atherosclerosis Management Program (CHAMP) and the Guidelines Applied in Practice (GAP).