A simple change in medication timing could prevent thousands of repeat heart attacks, according to new research from Lund University and Imperial College London. The study reveals that heart attack survivors who receive a combination treatment of statins and ezetimibe within 12 weeks show significantly better outcomes than those receiving delayed treatment.
For the millions who survive heart attacks globally each year, the risk of experiencing another one remains highest during the first 12 months. During this critical period, blood vessels are particularly vulnerable to new clot formation.
The international research team analyzed data from 36,000 Swedish patients who experienced heart attacks between 2015 and 2022. Their findings challenge the current step-by-step approach to treatment.
“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,” explains Dr. Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital.
The research, published in the Journal of the American College of Cardiology, used advanced statistical modeling to compare outcomes for three groups of patients: those receiving early combination therapy (within 12 weeks), those receiving delayed combination therapy (between 13 weeks and 16 months), and those receiving only statins without ezetimibe.
Results clearly showed that patients receiving early combination therapy had fewer subsequent cardiovascular events and lower mortality rates.
In the UK alone, where approximately 100,000 hospital admissions occur annually due to heart attacks, researchers estimate this treatment approach could prevent roughly 5,000 repeat heart attacks over a decade.
Professor Kausik Ray from Imperial College London’s School of Public Health stated: “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs. But 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.”
Both statins and ezetimibe work to lower LDL or “bad” cholesterol, but through different mechanisms. While statins reduce cholesterol production in the liver, ezetimibe blocks absorption in the intestines. Current guidelines typically recommend starting with high-potency statins, then adding ezetimibe later if needed.
The researchers’ modeling suggests that if 100% of patients received ezetimibe early, 133 heart attacks could be avoided per 10,000 patients within just three years.
Despite the compelling data, implementing early combination therapy faces hurdles. “Combination therapy is not applied up-front for two main reasons,” Dr. Leósdóttir explains. “General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and overmedication.”
However, she notes that ezetimibe causes few side effects and is both affordable and widely available in many countries.
Some hospitals are already changing their approach. Skåne University Hospital in Sweden introduced a treatment algorithm helping doctors prescribe appropriate lipid-lowering medications for heart attack patients. Early results show twice as many patients reaching target cholesterol levels two months after their heart attack compared to previous protocols.
Professor Ray emphasized the economic benefits: “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 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.”
With cardiovascular disease remaining the leading cause of death worldwide, Dr. Leósdóttir hopes more hospitals will review their procedures: “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.”
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