A powerful combination of two cholesterol-lowering drugs could prevent thousands of deaths each year from heart attacks, strokes and other cardiovascular diseases, according to the largest analysis of its kind.
Published in the journal Mayo Clinic Proceedings, the new research examined data from over 108,000 patients who were at very high risk of having a heart attack or stroke, or who had already suffered one.
The study found that using a statin alongside another drug called ezetimibe was significantly more effective than statins alone at lowering levels of so-called ‘bad’ cholesterol (low-density lipoprotein cholesterol, or LDL-C for short) and reducing deaths.
Statins have long been a cornerstone of heart disease prevention. They work by reducing cholesterol production in the liver. Ezetimibe, often prescribed when statins alone aren’t enough, complements this by limiting cholesterol absorption in the gut.
The analysis showed that patients who received both drugs from the outset saw a 19 per cent reduction in overall risk of death, a 16 per cent reduction in cardiovascular-related deaths, and nearly 20 per cent fewer major cardiovascular events – including heart attacks and strokes – compared to those taking only high-doses of statins.
Globally, cardiovascular disease kills 18 million people each year, according to the World Health Organization. High LDL-C alone was responsible for 4.5 million deaths in 2020, with the highest rates seen in Eastern Europe and Central Asia.
“We estimate that if combination therapy to reduce LDL-C was included in all treatment guidelines and implemented by doctors everywhere for patients with high cholesterol levels, it would prevent over 330,000 deaths a year among patients who have already suffered a heart attack, and almost 50,000 deaths alone in the USA," said Prof Maciej Banach, lead author of the study and cardiologist at the John Paul II Catholic University of Lublin in Poland.
LDL-C levels also dropped significantly more with combination therapy, increasing the chance of hitting the ideal target of under 70mg/dL by 85 per cent.
Historically, doctors have tended to prescribe statins first, then assess whether additional medication like ezetimibe is needed after a few months. But this new evidence supports a more proactive approach: start both drugs right away in high-risk patients.
Co-author of the study Prof Peter Toth added, “This study confirms that combined cholesterol-lowering therapy should be considered immediately and should be the gold standard for treatment of very high-risk patients after an acute cardiovascular event.”
The approach, Toth suggested, could even save healthcare systems money in the long run by avoiding the costly consequences of untreated or poorly managed cardiovascular disease – like heart failure and repeated strokes.
With statins widely available and ezetimibe already used in clinical practice, researchers hope the evidence will prompt a shift in treatment guidelines. Their message to doctors is clear: for patients at the highest risk, don’t wait – start both treatments early and together.
"Our findings underline the importance of the adage ‘the lower for better for longer’ but also the equally important ‘the earlier the better’ for treating patients at high risk of cardiovascular conditions and to avoid further medical complications and deaths," Toth said.
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