Early combination treatment can prevent heart attacks and save lives

Patients who receive add-on medications immediately after a heart attack have a significantly better prognosis than those who receive it later.

This is according to new research from researchers at Lund University in Sweden and Imperial College in London. Findings suggest that early treatment of patients with a combination of statin and the cholesterol-lowering drug ezetimibe can prevent thousands of new heart attacks over a decade.

Cardiovascular disease is the most common cause of death worldwide, and heart attacks (“myocardial infarction”) is the most common acute event. For those withstanding heart attacks, the risk of a new heart attack is maximized in the first year after the first event, making it easier for blood clots to develop because the blood vessels are more sensitive.

Reducing LDL or “bad” cholesterol in the blood can stabilize blood vessel changes and reduce the risk of new events. The current treatment guidelines for patients are advanced statins immediately after a heart attack to lower cholesterol levels. However, the majority of patients do not reach the recommended cholesterol levels using statins alone, so add-on treatments such as ezetimibe are required.

Today's guidelines recommend incremental additions of lipid-lowering treatments. However, in many cases, this escalation takes too long, ineffective, and patients are lost to follow-up. Giving patients with previous combination treatments can help prevent more heart attacks. ”

Margret Leósdóttir, Associate Professor at Lund University, Senior Cardiology Consultant at Skåne University Hospital, Malmö, Sweden

“This study shows that giving patients a combination of two low-cost drugs can save lives and reduce additional heart attacks. Types of heart events,” said Professor Kausik Ray, a co-researcher from the Department of Public Health at Imperial College London.

In the latest study, the international team looked at the outcomes of heart attack patients when statins and add-on therapy ezetimibe (within 12 weeks after a heart attack) and statins, post-ezetimibe-containing statins (13 weeks to 16 months), or no statins without ezetimibe were added.

Based on Swedish registry data from 36,000 patients who suffered heart attacks between 2015 and 2022, the researchers used sophisticated statistical models to emulate clinical trials. Results show that patients who received combination statin and ezetimibe treatment within 12 weeks of a heart attack and were able to lower their cholesterol early and early. prognosis Also, there is less or less risk of new cardiovascular events and death than those who received add-on treatment later on.

From the analysis, researchers believe that if treatment strategies change, many new heart attacks, strokes, and deaths could be prevented internationally every year. We estimate that 133 heart attacks can be avoided in a population of 10,000 patients over three years under a scenario in which 100% of patients receive ezetimibe early.

Researchers suggest that in the UK, which records an estimated 100,000 hospitalizations from a yearly heart attack, this amounts to preventing an estimated 5,000 heart attacks over a decade.

Dr. Leosdottil said: “Combination therapy is not prepaid for two main reasons. General recommendations are not included in today's guidelines, and precautionary principles apply to avoid side effects and over-employment. However, there is a positive effect from applying both medications as soon as possible after infarction. In many countries.”

Margret Leósdóttir hopes that the findings will support changes to recommendations in time. Treatment algorithms have already been introduced in her hospital in Sweden, helping doctors prescribe appropriate lipid-lowering treatments for patients suffering from myocardial infarction. It has been noted that patients with twice the infarction achieved their treatment goals early after twice the time they reduced their poor cholesterol to the target level compared to before.

“Several other hospitals in Sweden have adopted algorithms, and there are similar examples from other countries that have produced good results. My hope is that more patients will be able to receive appropriate treatment in time, thereby preventing unnecessary pain and saving lives.”

Professor Ray added: “It suggests that simple changes to treatment guidelines can have a significant impact on patients and reduce the demand for the NHS. Ezetimibe is already widely available and is prescribed at a relatively low cost.