Patients who have suffered a heart attack should immediately be offered a combination of cholesterol lowering drugs with statins and ezetimibe, according to research published in the Journal of the American Heart Association.
The study showed that people with acute coronary syndrome (ACS), which includes those who have experienced a heart attack or unstable angina, are 47% less likely to die within three years if they start taking a high dose statin and ezetimibe straight away, compared to those only taking a high dose statin.
Researchers say that if treatment guidelines are changed to reflect these findings, it could prevent many thousands of deaths each year.
The research was led by Maciej Banach, Professor of Cardiology at the Medical University of Lodz, Poland, and Adjunct Professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, U.S..
The study included data on 1,536 patients with ACS who were part of the national Polish Registry of Acute Coronary Syndromes (PL-ACS). Half had been treated with a high dose statin only. The other half were treated with a combination of a high dose statin and ezetimibe.
It revealed that those who started taking a statin and ezetimibe straight away were less likely to die of any cause in following the three years. However, the risk of death was already lower after only 52 days of treatment. The results suggest that out of every 21 patients taking the double treatment for three years, one death was prevented.
Both statins and ezetimibe are widely available drugs that have been shown to effectively lower the amount of cholesterol in the blood. When people have high levels of cholesterol it can block their blood vessels increasing the risk of heart disease, stroke or peripheral artery disease.
ACS affects around seven million people worldwide, including around four million heart attack patients. Researchers say that ensuring that all those at risk are started on both treatments straight away could prevent an estimated 330,000 deaths per year.
Professor Banach said, “Patients with acute coronary syndrome, such as those who have already had a heart attack, face a much higher risk of further heart problems. Current guidelines, including those on prevention from the European Society of Cardiology, recommend a stepwise approach, first offering a statin only. This study shows that if we act quickly and decisively to lower patients’ cholesterol with this combination of treatments, we can drastically reduce the risk of death.”
“Around seven million people suffer acute coronary syndrome every year and the majority of cases are linked to high cholesterol and a build-up of fat in the blood vessels. We have effective cholesterol lowering treatments, but we must make sure the people who need them are taking them.”
More information:
Joanna Lewek et al, Intensive Statin Therapy Versus Upfront Combination Therapy of Statin and Ezetimibe in Patients With Acute Coronary Syndrome: A Propensity Score Matching Analysis Based on the PL‐ACS Data, Journal of the American Heart Association (2023). DOI: 10.1161/JAHA.123.030414
Journal information:
Journal of the American Heart Association
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