A simple combination of drugs could prevent thousands of heart attacks, according to a study published in the Journal of the American College of Cardiology (JACC). The team from Lund University in Sweden and Imperial College London found that treating patients earlier with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of new heart attacks.
Cardiovascular disease is the most common cause of death worldwide, and heart attack (medically known as myocardial infarction) is the most common event. Experiencing a heart attack increases the risk of another heart attack in the first year because the blood vessels become more sensitive, making it easier for blood clots to develop.
Reducing LDL—bad cholesterol—can stabilise changes in the vessels and lower the risk for new events. At the moment, patients start on high-potency statins immediately after a heart attack to lower cholesterol levels. However, this is not enough for the majority of patients, and some need an add-on treatment, such as ezetimibe.
“Today’s guidelines recommend stepwise addition of lipid-lowering treatment. But it’s often the case that this escalation takes too long, it’s ineffective, and patients are lost to follow-up,” said Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital in Malmö, Sweden. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”
“This 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. Our study shows the way forward; care pathways must now change for patients after this type of heart event,” added Professor Kausik Ray from Imperial College London’s School of Public Health.
In this study, the team examined long-term outcomes for heart attack patients who received a combination of statins with the add-on therapy ezetimibe (within 12 weeks after a heart attack), statins with ezetimibe added later (more than 13 weeks later), or statins with no ezetimibe at all.
The results from 36,000 participants who experienced a heart attack between 2015 and 2022 showed that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack managed to lower cholesterol earlier, had a better prognosis and less risk of new cardiovascular events and death compared to those who received the add-on treatment later, or not at all.
The results suggest that this combination of medications could prevent many heart attacks, strokes, and deaths every year. If all patients were to receive ezetimibe early, the authors estimate it could prevent 133 heart attacks per 10,000 patients in 3 years. In the UK, for example, an estimated 5,000 heart attacks could be prevented over ten years.
“Combination therapy is not applied up-front for two main reasons. General recommendations are not included in today’s guidelines, but a precautionary principle is applied to avoid side effects and overmedication. 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,” said Dr Leósdóttir.
The researchers hope these results will support changes in the recommendations for patients after a heart attack. A treatment has already been introduced in a hospital in Sweden to help doctors prescribe appropriate lipid-lowering treatment for patients who have had a myocardial infarction. Patients achieve their treatment goals earlier, and only two months after the event, twice as many patients have reduced their bad cholesterol to the target level compared with previously.
“Several other hospitals in Sweden have also adopted the algorithm, and there are similar examples from other countries that have produced as good results. My hope is that even more will review their procedures so that more patients will get the right treatment in time, and we can thereby prevent unnecessary suffering and save lives,” said Professor Ray. “Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS. 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.”
Leosdottir M, Schubert J, Brandts J, Gustafsson S, Cars T, et al. (2025) Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry. Journal of the American College of Cardiology (JACC) https://doi.org/10.1016/j.jacc.2025.02.007