A new study by Lund University and Imperial College London reveals that initiating a combination of statins and ezetimibe in patients recovering from myocardial infarction (MI) could significantly reduce recurrent heart attacks and cardiovascular deaths. The research suggests a shift in post-MI care pathways to prioritize earlier dual lipid-lowering therapy (LLT).

Key Highlights

Study Design and Population

• The study evaluated 35,826 MI patients (median age: 65.1 years) from 2015 to 2022.

• Patients were either treated with statins alone or statins plus ezetimibe, with varying initiation times (≤12 weeks, 13 weeks–16 months, or not at all).

Clinical Findings

• Early combination therapy group showed the greatest reduction in low-density lipoprotein cholesterol (LDL-C) at 1-year follow-up.

• The early cohort also had the lowest incidence of major adverse cardiovascular events (MACE) over 3.96 years.

Risk Analysis Results

• Patients who did not receive ezetimibe had a 29% higher risk of MACE compared to the early treatment group.

• Cardiovascular death risk was also higher in late and no-ezetimibe groups:

• 1.64 aHR for late group

• 1.83 aHR for no-ezetimibe group

Impact on Healthcare

• The Number Needed to Treat (NNT) to prevent one MACE:

  1. 53 from statin monotherapy to early combo

  2. 143 from delayed combo to early combo

• Early treatment could have prevented 447 events in the study population.

Quotes from Experts
Prof. Margrét Leósdóttir, Lund University:
 “By giving patients a combination treatment earlier, we could help prevent many more heart attacks.”Prof. Kausik Ray, Imperial College London:
 “We could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs. Our study shows the way forward — care pathways must now change for patients after this type of heart event.”The study advocates for a change in standard cardiac care post-MI. Introducing a cost-effective combination of statins and ezetimibe early post-discharge may significantly reduce cardiovascular risks and save lives. Experts are urging global health systems to update treatment guidelines to reflect this new evidence.