Statin therapy for a middle-aged man with myocardial infarction

A 50-year-old man with diabetes and hypertension was admitted to the hospital for severe, substernal chest pain. An electrocardiogram showed normal sinus rhythm with no acute ST-segment abnormality. The creatine kinase, creatine kinase-MB isoenzyme, and troponin-T biomarkers were significantly elevated above the normal limit. The patient was diagnosed with non—ST-segment elevation myocardial infarction. He was treated and stabilized with standard medical therapy.

The patient's lipid panel drawn within 4 hours of presentation showed the following values: total cholesterol, 221 mg/dL; low-density lipoprotein (LDL) cholesterol, 122 mg/dL; and high-density lipoprotein cholesterol, 41 mg/dL. Coronary angiography showed a 90% stenosis in the proximal portion of his dominant right coronary artery (culprit lesion), as well as diffuse nonobstructive coronary disease in the left anterior descending and left circumflex coronary arteries. Percutaneous coronary intervention with stenting of the culprit lesion was successfully performed.

The patient's discharge medication regimen included aspirin, clopidogrel (Plavix), a ß blocker, an angiotensin-converting enzyme inhibitor, and an HMG-CoA reductase inhibitor (statin) for secondary prevention of future adverse cardiovascular events. Current National Cholesterol Education Program guidelines recommend that cholesterol-lowering medications be initiated if the serum LDL cholesterol level is greater than 100 mg/dL in high-risk patients and those with known coronary heart disease. Based on the data shown in "Intensive Statin Therapy in Acute Coronary Syndrome," what is the optimal time and dosage for the initiation of statin therapy in patients presenting with acute coronary syndrome?