Early combination drug therapy slashes heart attack risk

Right after a heart attack, the risk of having another one is very high. This is the most dangerous time for your heart. Blood vessels are still fragile and more likely to form dangerous clots. That’s why fast and effective treatment is so important. Doctors often use powerful medications right away to lower cholesterol. But these medications don’t always do enough. When that happens, many patients need more than one drug to reach safe levels of “bad” cholesterol, known as LDL-C.

Medical experts have known for years that lowering LDL-C helps prevent future heart problems. Despite this, many treatment guidelines still recommend starting with a single drug, a statin, and only adding another drug if it doesn’t work. This slow approach might seem cautious, but in real life, it often takes too long. Many patients don’t follow up regularly. Others don’t get the extra medication they need in time. And that delay can cost lives.

Heart attacks happen when blood flow to part of the heart muscle gets blocked. This usually occurs because fatty deposits in blood vessels, called plaques, rupture and trigger clots. One of the key ways to prevent another attack is to stabilize these plaques. Lowering LDL-C helps do this.

Statins, which reduce the body’s cholesterol production, are the first line of defense. They are usually given in high doses immediately after a heart attack. But less than 20% of patients actually reach their LDL-C goals using statins alone. This shows how often additional medication becomes necessary. That’s where a second drug called ezetimibe comes in. Ezetimibe works by reducing the absorption of cholesterol in the gut, targeting a different part of the body’s cholesterol process. When combined with a statin, it can lower LDL-C even more.

Margrét Leósdóttir, a cardiologist and researcher from Lund University, wanted to find out whether giving ezetimibe earlier could make a difference. She and her team looked at data from 36,000 patients in Sweden who had heart attacks between 2015 and 2022. Using advanced statistical tools, they created a model that mimics a clinical trial.

They compared three groups of patients: those who got ezetimibe within 12 weeks of their heart attack, those who got it between 13 weeks and 16 months later, and those who never got it. The findings were clear. People who started ezetimibe early had fewer future heart problems and a lower risk of death. They reached healthy LDL-C levels faster. And they stayed healthier longer.

“Today’s guidelines recommend stepwise addition of lipid-lowering treatment,” said Leósdóttir. “But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up.”

This slow approach may make sense on paper, but in reality, people slip through the cracks. They might miss appointments, forget medications, or never get the right dosage. Starting with both drugs right after the heart attack avoids these problems and gives patients the best chance from the beginning.

Leósdóttir’s study challenges how doctors usually treat patients after a heart attack. The research supports using both drugs right away instead of waiting to see if one works. “Combination therapy is not applied up-front for two main reasons,” she explained. “General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and overmedication.”

But the medication she studied—ezetimibe—has few side effects, is affordable, and is easy to find in many countries. That makes it a strong candidate for use soon after a heart attack. Waiting comes with real risks. Patients miss the chance to protect their heart when it’s most vulnerable.

At her hospital in Sweden, Leósdóttir and her team have already changed how they treat patients. They introduced a new treatment plan, or algorithm, that helps doctors decide when to prescribe ezetimibe. Since they started using it, more patients have reached their LDL-C goals in a shorter amount of time. Just two months after a heart attack, twice as many patients have lowered their LDL-C to safe levels compared to before.

“Several other hospitals in Sweden have also adopted the algorithm and there are similar examples from other countries that have produced as good results,” said Leósdóttir. “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.”

Many guidelines still push for a slow, cautious step-by-step plan. This makes sense when trying to avoid overmedication, but Leósdóttir’s research shows the benefits of acting quickly. In real-world practice, delays often mean people never get the treatment they need. Their cholesterol stays too high, and their risk of another heart attack remains dangerously elevated.

Leósdóttir believes that with better data and successful results from new methods, medical guidelines may change. If health systems adopt faster and more aggressive treatment strategies, they could prevent thousands of new heart attacks, strokes, and deaths every year.

There’s a reason doctors push to lower LDL-C. It plays a direct role in plaque buildup, which can lead to clogged arteries. Studies show that the lower the LDL-C, the lower the risk of heart problems. And combining medications that work in different ways is one of the most powerful tools available.

When given early, the statin-ezetimibe combo works fast and effectively. It reduces LDL-C more than either drug alone. It helps the blood vessels heal and lowers the chance of future blockages. It also fits into health systems easily because ezetimibe is not expensive or difficult to access.

This treatment method could also help make heart care more equal. In many places, people face barriers to consistent follow-up care. A plan that gives patients the best medication up front reduces the need for multiple checkups. It helps people who might otherwise be overlooked.

Heart attacks remain the top killer around the world. Every second counts in recovery and in preventing the next event. The evidence now suggests that using both statins and ezetimibe right after the first heart attack gives patients the best chance to stay healthy.

The research from Sweden adds to a growing body of data calling for faster, more effective action. It questions the slow, stepwise treatment model and offers a clear alternative. Giving the right medications early can lead to better results, safer patients, and fewer hospital visits.

It may be time to rethink old habits and follow the data toward a future with fewer heart attacks and more lives saved.

Research findings are available online in the Journal of the American College of Cardiology.

Note: The article above provided above by The Brighter Side of News.

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