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LONDON & LUND – Administering a combination of cholesterol-lowering drugs soon after a heart attack could significantly improve patient outcomes and prevent thousands of subsequent cardiovascular events, according to a new study by researchers at Imperial College London and Lund University in Sweden.
The research highlights that patients receiving both statins and the add-on medication ezetimibe within 12 weeks of a myocardial infarction (heart attack) have a markedly better prognosis compared to those who receive the additional drug later, or only receive statins.
Cardiovascular disease remains the leading cause of death globally, with heart attacks being a frequent and serious manifestation. Survivors face a heightened risk of another event, particularly within the first year, as blood vessels are more prone to clot formation. Lowering LDL (“bad”) cholesterol is crucial for stabilising blood vessels and reducing this risk.
Current standard practice involves prescribing high-potency statins immediately post-heart attack. However, many patients fail to reach recommended cholesterol targets with statins alone, necessitating additional treatments like ezetimibe.
“Today’s guidelines recommend stepwise addition of lipid-lowering treatment. But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up,” explained Dr. Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”
The study, published in the Journal of the American College of Cardiology (JACC), analyzed Swedish registry data from 36,000 heart attack patients between 2015 and 2022. Using advanced statistical models to simulate a clinical trial, the researchers compared outcomes for three groups: those receiving statins plus ezetimibe within 12 weeks, those adding ezetimibe later (13 weeks to 16 months), and those receiving only statins.
The results clearly indicated that early initiation of the combination therapy (within 12 weeks) led to a better prognosis and a lower risk of subsequent cardiovascular events and death.
The researchers estimate that if all patients received ezetimibe early, 133 major adverse cardiovascular events (like heart attacks or strokes) could be avoided per 10,000 patients over three years. Extrapolating this, they suggest that in the UK, where approximately 100,000 heart attack-related hospital admissions occur annually, implementing this early combination strategy could prevent an estimated 5,000 heart attacks over a ten-year period.
Professor Kausik Ray from Imperial College London’s School of Public Health emphasised the potential impact: “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs… At the moment patients across the world aren’t receiving these drugs together. That’s causing unnecessary and avoidable heart attacks and deaths – and also places unnecessary costs on healthcare systems.”
Professor Ray noted the cost-effectiveness, stating ezetimibe could be rolled out for around £350 per patient per year, offering significant savings compared to treating recurrent heart attacks.
Dr. Leósdóttir acknowledged that current guidelines and a cautious approach often delay combination therapy. However, she stressed the benefits of early action and the favourable side-effect profile of ezetimibe. Some hospitals, including her own, have already adopted treatment algorithms encouraging earlier combination therapy, observing faster achievement of cholesterol targets among patients.
“My hope is that even more will review their procedures, so that more patients will get the right treatment in time, and we can thereby prevent unnecessary suffering and save lives,” Dr. Leósdóttir concluded.
Disclaimer: This news article is based on findings from the study ‘Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry’ published in the Journal of the American College of Cardiology (DOI: 10.1016/j.jacc.2025.02.007). It is intended for informational purposes only and does not constitute medical advice or a replacement for professional medical consultation. Treatment decisions should always be made in discussion with a qualified healthcare provider based on an individual’s specific medical condition and history.
