In accordance with the recommendations of the American College of Cardiology/American Heart Association Joint Task Force, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) are prescribed before hospital discharge after an episode of acute coronary syndrome. Yet, optimal timing and dosage have not been agreed upon. Recent evidence suggests a pleiotropic mechanism of action including vasoprotective, anti-inflammatory, and antiarrhythmic properties that imply an immediate role for statin medications. Our review suggests that early (<24 hours) high dose (80 mg of atorvastatin) statins may significantly reduce adverse cardiovascular outcomes and may improve long-term mortality.