A new study from researchers at Lund University in Sweden and Imperial College London suggests that treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks. 

For those who survive a heart attack, the risk of a new heart attack is greatest in the first year after the initial event. 

The current treatment guidelines for patients are high-potency statins immediately after a heart attack. However, the majority of patients do not reach recommended cholesterol levels using only statins, and so need an add-on treatment, such as 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,” says Margrét Leósdóttir, Associate Professor at Lund University and Senior Cardiology Consultant at Skåne University Hospital in Malmö, Sweden. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.” 

The international team examined outcomes for heart attack patients if they received a combination of statins with the add-on therapy ezetimibe (within 12 weeks after a heart attack), statins with ezetimibe added later (between 13 weeks and 16 months), or just statins with no ezetimibe at all. 

Based on Swedish registry data from 36,000 patients who had a heart attack between 2015 and 2022, the researchers used advanced statistical models to emulate a clinical trial. 

The results show that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack and were able to lower cholesterol to the target level early, had a better prognosis and less risk of new cardiovascular events and death than those who received the add-on treatment later, or not at all.

Diana Spencer, Senior Digital Content Editor, DDW