Patients who receive an add-on medication soon after a heart attack have a significantly better prognosis than those who receive it later, or not at all.
This is according to a new study from researchers at Lund University in Sweden and Imperial College London. The findings suggest that treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks over a decade.
Cardiovascular disease is the leading cause of death worldwide, with heart attack (myocardial infarction) being the most common acute event. For those who survive a heart attack, the risk of a new attack is highest in the first year due to increased vessel sensitivity, which makes it easier for blood clots to form.
Reducing LDL or “bad” cholesterol helps stabilize blood vessels, lowering the risk of another event. Current guidelines recommend high-potency statins after a heart attack, but most patients fail to reach target cholesterol levels with statins alone, making add-on treatments like ezetimibe necessary.
“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,” said Margrét Leósdóttir, Associate Professor at Lund University. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”
Professor Kausik Ray from Imperial College London emphasized, “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs.”
The study analyzed Swedish registry data from 36,000 patients who had heart attacks between 2015 and 2022. Patients were grouped by whether they received statins with ezetimibe within 12 weeks, later (13 weeks to 16 months), or never. Results showed early combination therapy led to significantly lower risks of cardiovascular events and death.
Researchers estimate that if 100% of patients received early ezetimibe treatment, 133 heart attacks could be prevented in a population of 10,000 over three years. In the UK, this could mean 5,000 fewer heart attacks over a decade.
Dr. Leósdóttir said the combination therapy is often delayed due to a lack of immediate guideline recommendations and concerns about side effects. However, ezetimibe has few side effects, is affordable, and is already widely available.
She also noted that a treatment algorithm has been implemented in Swedish hospitals, doubling the number of patients reaching target cholesterol levels within two months. Similar results are seen in other countries.
Professor Ray concluded, “Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS. Ezetimibe is already available and low-cost—this therapy could be rolled out at around £350 per patient per year, saving lives and healthcare resources.”
The study is published in Journal of the American College of Cardiology.
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