Combined therapy can prevent thousands of cardiovascular deaths

The biggest analysis examining the best ways to lower “bad” cholesterol levels in blocked arterial patients shows that not just statins, but alternative drug combinations called statins and ezetimibe should be given immediately. This can prevent thousands of deaths per year from heart attacks, strokes and other cardiovascular diseases.

Meta-analysis of 108,353 patients in 14 studies that are extremely at high risk of suffering heart attacks and strokes, or those who have already suffered from any of these cardiovascular events, have been published in the journal Mayo Clinic minutes. Ezetimibe combined with high-dose statins to reduce levels of low-density lipoprotein cholesterol (LDL-C) showed a significant reduction in the risk of death from any cause, a 16% reduction in cardiovascular causes and a significant reduction in the incidence of secondary cardiac events.

Additionally, combination therapy significantly reduced additional LDL-C levels of 13 mg per blood deciliter (DL) compared to statin alone, measured from baseline (time the patient first started treatment). This increased the likelihood of reaching an ideal target of less than 70 mg/dL for LDL-C by 85%.

“These results are even more pronounced in the network meta-analysis, allowing for a direct comparison of the various treatment regimens used in the study, which showed a 49% reduction in all-cause mortality when compared with high-dose statin therapy alone, and a 39% reduction in major adverse cardiovascular events when compared with high-dose statin therapy alone. Johns Hopkins University School of Medicine, adjunct professor at the Ciccarone Center for Fardiovascular Disease Center, also leads the Blood Pressure Meta-Analysis Collaboration Group, which conducted the research with the International Panel of Lipid Experts.

“Combination therapy is safe and effective. The risk of adverse events and treatment discontinuation rates were comparable across groups. Network meta-analysis showed a significant reduction in the risk of discontinuation in patients treated with moderate dose statin therapy and ezetimibe alone.”

Previously, there have been inconsistent findings about whether cholesterol-lowering therapy should be given immediately to high-risk patients, even before suffering from a heart attack or stroke, or whether doctors should start these patients with high-dose statins first and monitor the effects of cholesterol levels at least two months ago if patients require ezetimibe.

“This study confirms that cholesterol-lowering therapy should be considered immediately and that for patients with keen hearts, it should be the gold standard for treating highly at-risk patients for patients with pivotal hearts. The impact of suboptimal statin monotherapy in many patients is associated with achieving more effective LDL-C goals, leading to a significant reduction in cardiovascular health issues and death.

“This approach doesn't require additional funding or refunds for new, expensive drugs. In fact, it can lead to low rates of complications like heart failure, which are extremely expensive for all healthcare systems, and subsequent heart attacks and strokes.”

According to global burdens of disease and data from the American Heart Association, deaths resulting from high LDL-C were the highest in Eastern Europe and Central Asia, with 4.5 million deaths worldwide resulting in 2020.

Cardiovascular disease kills around 20 million people worldwide a year. Based on previous analysis, it estimates that combination therapy to reduce LDL-C is included in all treatment guidelines, and that if administered by a physician anywhere for patients with high cholesterol levels, it will prevent more than 330,000 deaths per year among patients with already suffering heart attacks and almost 50,000 deaths in the United States. Combination therapy is considered the gold standard for treatment of these patients and is recommended to be included in all future treatment guidelines. ”

Masiezivanach, Professor of Cardiology, Catholic University, John Paul II, Poland

Statins have been safely used for years. It helps to lower LDL-C by reducing the production of LDL-C by the liver. Ezetimibe reduces the amount of cholesterol the body takes from food by inhibiting intestinal absorption. Some patients do not respond appropriately to statins and are prescribed ezetimibe in combination with statins. High-dose statins are known as “high-strength” statins, while medium-high-dose are known as “moderate-strength” or “moderate-strength” statins.

Professor Toss said: “Our findings underscore the importance of sayings.”The lower the price will be longer“But it's just as important.”The sooner the better“To treat patients at high risk of cardiovascular disease and to avoid further medical complications and death.”

The strength of the study is its large size, as it includes the maximum number of patients studied so far. Patients were included in 14 studies, of which 11 were randomized controlled trials and three were cohort studies. Limitations are primarily related to the type of research included in the meta-analysis. Include their size and some of their observational properties.