It is reasonable to obtain a fasting lipid profile in patients with STEMI, preferably within 24 hours of presentation. (Level of Evidence: C) Treatment with statins in patients stabilized after an ACS, including STEMI, lowers the risk of coronary heart disease death, recurrent MI, stroke, and the need for coronary revas- More intensive statin therapy, compared with less intensive therapy, appears to be associated with an additional lowering of nonfatal clinical endpoints.434,436,439 Among currently available statins, only high-dose atorvas- tatin (80 mg daily) has been shown to reduce death and isch- emic events among patients with ACS.436,440 Approximately one third of patients in the PROVE-IT TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy Throm- bolysis in Myocardial Infarction 22) trial had STEMI.436 Car- diovascular event rates were not significantly reduced with a tiered strategy of simvastatin (40 mg daily for 1 month followed by 80 mg daily) in the A to Z Trial (Aggrastat to and concerns have been raised recently about the safety of high-dose simvastatin (ie, 80 mg daily).441 Although the benefit of high-intensity statins declines among statin- na ve patients with ACS as a function of decreasing low-den- sity lipoprotein levels,442 the writing committee recommends the use of statins in all patients with STEMI.435 Statin therapy after ACS is beneficial even in patients with baseline low- density lipoprotein cholesterol levels <70 mg/dL.443 Trials of statin therapy in patients with ACS and stable ischemic heart disease have been designed to compare either more intensive versus less intensive statin treatment or active statin versus They have not been designed to compare clini- cal outcomes as a function of the specific low-density lipo- protein cholesterol level achieved with treatment. Improved compliance with therapy is a strong rationale for timing the initiation of lipid-lowering drug therapy before discharge after STEMI. 