An international research team has discovered that early intervention with a combination of cholesterol-lowering medications could significantly reduce the risk of recurrent heart attacks and save thousands of lives annually.
Scientists from Imperial College London and Lund University in Sweden found that patients who received both statins and ezetimibe within 12 weeks of experiencing a heart attack showed markedly better outcomes compared to those who received delayed combination therapy or statins alone.
"This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs," said Professor Kausik Ray from Imperial College London's School of Public Health. "But at the moment patients across the world aren't receiving these drugs together. That is causing unnecessary and avoidable heart attacks and deaths."
Significant Findings from Comprehensive Analysis
The research team examined data from 36,000 patients who experienced heart attacks between 2015 and 2022, using advanced statistical models to emulate a clinical trial. They compared outcomes across three groups: patients who received statins with ezetimibe within 12 weeks of a heart attack, those who received the combination between 13 weeks and 16 months, and patients who received only statins.
Results clearly demonstrated that early combination therapy led to better cholesterol control and significantly reduced the risk of new cardiovascular events and death. The findings align with a separate evidence review published in Mayo Clinic Proceedings, which analyzed data from 14 studies involving over 108,000 high-risk heart patients.
This larger analysis found that combining statins with ezetimibe:
- Increased chances of reaching healthy LDL cholesterol levels by 85%
- Reduced all-cause mortality risk by 19%
- Decreased heart-related deaths by 16%
- Lowered major cardiovascular event risk by 18%
- Reduced stroke risk by 17%
Mechanism of Action and Timing
The complementary mechanisms of these medications appear key to their effectiveness. While statins interfere with the liver's ability to produce cholesterol, ezetimibe reduces cholesterol absorption in the intestines.
Timing of intervention is crucial, as patients face the highest risk of suffering another heart attack within the first year after the initial event. During this period, blood vessels remain sensitive and prone to clot formation.
"By giving patients a combination treatment earlier, we could help to prevent many more heart attacks," explained Dr. Margret Leosdottir, associate professor at Lund University and senior cardiology consultant at Skane University Hospital in Malmo, Sweden.
Potential Public Health Impact
The researchers estimate that if 100% of eligible patients received ezetimibe early, approximately 133 heart attacks could be prevented per 10,000 patients over three years. With approximately 100,000 hospital admissions for heart attacks annually in the UK, this approach could prevent an estimated 5,000 heart attacks over a decade.
On a global scale, the combination therapy could prevent more than 330,000 deaths annually among patients who have already suffered a heart attack, including nearly 50,000 deaths in the United States alone.
Cost-Effective Solution
Professor Ray emphasized the economic feasibility of this approach: "Ezetimibe is already widely available and prescribed for relatively low cost. This add-on therapy could be rolled out for around £350 a year per patient, which is a huge cost saving compared to the lasting impacts of treating heart attacks and the impact they have on patients' lives."
Dr. Peter Toth, professor of clinical family and community medicine at the University of Illinois, noted that "this approach does not require additional funding or reimbursement of new expensive drugs. In fact, it may translate into lower rates of first and subsequent heart attacks and stroke, and their complications like heart failure, which are extremely costly for all healthcare systems."
Current Practice and Future Directions
Despite the compelling evidence, combination therapy is not yet standard practice. Dr. Leosdottir explained: "Combination therapy is not applied up-front for two main reasons. General recommendations are not included in today's guidelines and a precautionary principle is applied to avoid side effects and over-medication."
However, she emphasized that "there are positive effects from applying both medicines as soon after the infarction as possible. Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries."
The researchers are calling for updated clinical guidelines and care pathways to reflect these findings, emphasizing both "the lower for better for longer" and "the earlier the better" approaches for high-risk cardiovascular patients.
