Giving patients a combination of drugs earlier in their treatment could prevent thousands of heart attacks, a new study suggests.
Researchers at Lund University in Sweden and Imperial College London say patients should be treated earlier with statins and the cholesterol-lowering drug ezetimibe.
The international team of scientists investigated ways to tackle cardiovascular disease, for which heart attacks (myocardial infarction) are the most common acute event.
Professor Kausik Ray, from Imperial College London’s School of Public Health, said the study found “we could save lives” by giving patients a combination of the two low-cost drugs.
“But at the moment patients across the world aren’t receiving these drugs together,” he said.
“That is causing unnecessary and avoidable heart attacks and deaths – and also places unnecessary costs on healthcare systems. Our study shows the way forward. Care pathways must now change for patients after this type of heart event.”
The results for patients if they received statins with the add-on therapy ezetimibe at different times after their heart attacks were examined by the scientists.
They looked at the potential impact on patients if they received a combination of statins and ezetimibe within 12 weeks of a heart attack, those who were given statins with ezetimibe added between 13 weeks and 16 months, and others who got just statins with no ezetimibe at all.
Data from 36,000 patients who had a heart attack between 2015 and 2022, according to the Swedish registry, was used along with advanced statistical models to emulate a clinical trial.
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, according to the study.
Professor Ray said: “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.”
Researcher Margret Leosdottir, Lund University associate professor and senior cardiology consultant at Skane University Hospital in Malmo, Sweden, welcomed the results, saying that “by giving patients a combination treatment earlier, we could help to prevent many more heart attacks”.
Patients are at the greatest risk of suffering a new heart attack in the first year after the initial event.
This is because the blood vessels are more sensitive and it is easier for blood clots to develop.
Reducing “bad” cholesterol in the blood can stabilise changes in the vessels and cut the risk of new events, the scientists said.
Many new heart attacks, strokes and deaths could be prevented every year internationally if the treatment strategy were changed, according to the researchers.
If 100 per cent of patients received ezetimibe early, they estimate 133 heart attacks could be avoided in a population of 10,000 patients in three years.
There are an estimated 100,000 hospital admissions from heart attacks a year in the UK, the researchers said.
This would equate to an estimated 5,000 heart attacks being prevented over a 10-year period, they suggest.
Dr Leosdottir said there are reasons why medics are cautious about combination therapy.
She said: “Combination therapy is not applied up-front for two main reasons. General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and over-medication.
“However, there are positive effects from applying both medicines as soon after the infarction as possible.
“Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”
