BACKGROUND: The natural history of atherosclerosis might involve coronary plaque 
rupture/erosion, thrombus formation and vessel lumen occlusion, clinically 
recognized as acute coronary syndrome (ACS). International guidelines strongly 
recommend early statin administration in patients admitted for ACS. In addition 
to lowering circulating levels of low-density lipoprotein cholesterol (LDL-c), 
statin treatment was shown to promote plaque stabilization or regression in 
several ways, including reduction in necrotic lipid core, anti-inflammatory 
effects and improvement in endothelial function. The aim of this review is to 
summarize clinical evidence on the role of statins in secondary prevention of 
ACS.
MATERIALS AND METHODS: This narrative review is based on the material found on 
medline and pubmed up to August 2013. We looked for the terms 'statin, acute 
coronary syndromes' in combination with 'atherosclerosis, acute myocardial 
infarction, pathophysiology'.
RESULTS: This review article emphasizes the relevance of the timing of statin 
administration to improve the outcomes after ACS. Early and continuous statin 
administration has emerged as key features to prevent adverse events, especially 
in patients admitted for ACS undergoing percutaneous coronary intervention. 
Clinical trials matching the improved clinical outcome with the imaging of 
atherosclerotic plaque stabilization/regression, further supporting the 
effectiveness of statin therapy. However, the achievement of these goals 
requires high dose of statins, thus increasing the risk of adverse events.
CONCLUSIONS: Although clinical trials and meta-analyses have provided 
conflicting results, it is likely that in clinical practice, the rate of adverse 
events is higher, so that many concerns still remain about a statin high-dose 
approach in ACS patients.