Combining two low-cost drugs may help prevent new heart attack, stroke risk

Treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks, strokes, and death over a decade, according to a new study.

Cardiovascular disease is by far the most common cause of death worldwide, with heart attack (myocardial infarction) being the most common acute event.

For those who survive a heart attack, the risk of a new heart attack is most significant in the first year after the initial event because the blood vessels are more sensitive, making it easier for blood clots to develop.

Reducing LDL or “bad” cholesterol in the blood can stabilise changes in the vessels, decreasing the risk for new events, said researchers from Lund University in Sweden and Imperial College London.

As per current treatment guidelines, patients are prescribed statins immediately after a heart attack. However, most patients do not reach recommended cholesterol levels using only statins, and so need an add-on treatment, such as ezetimibe, the team suggested.

“The 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,” said co-investigator Professor Kausik Ray, from Imperial College London’s School of Public Health.

“Our study shows the way forward; care pathways must now change for patients after this type of heart event,” he added.

In the study, the international team examined outcomes for heart attacks in 36,000 patients who had a heart attack between 2015 and 2022.

The results show that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack were able to lower cholesterol to the target level early. They also 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.

The team said that many new heart attacks, strokes, and deaths could be prevented every year internationally if the treatment strategy were to be changed.

Under a scenario in which 100 per cent of patients would receive ezetimibe early, they estimate 133 heart attacks could be avoided in a population of 10,000 patients in 3 years, they said.