Earlier treatment with combination of drugs could prevent 5,000 heart attacks per decade, study results suggest

Around 5,000 heart attacks could be prevented in the UK every decade by treating patients with a combination of statins and the cholesterol-lowering drug ezetimibe sooner after a heart attack, study results have shown.

The study, published in the Journal of the American College of Cardiology on 14 April 2025, examined outcomes for heart attack patients if they received a combination of statins with the add-on therapy ezetimibe within 12 weeks after a heart attack, statins with ezetimibe added later between 13 weeks and 16 months or just statins with no ezetimibe at all.

Based on Swedish registry data from 36,000 patients who had a heart attack between 2015 and 2022, the results showed that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack and were able to lower cholesterol to the target level early, 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 study researchers concluded that many new heart attacks, strokes and deaths could be prevented every year.

In a scenario in which 100% of patients would receive ezetimibe early, the researchers estimated that 133 heart attacks could be avoided in a population of 10,000 patients in three years.

The results also suggested that an estimated 5,000 heart attacks in the UK could be prevented over a ten-year period.

Study co-author Kausik Ray, professor of public health and honorary cardiologist at Imperial College London, said not giving patients these drugs together is “causing unnecessary and avoidable heart attacks and deaths” and also places “unnecessary costs” on healthcare systems.

“Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS,” he added.

“Ezetimibe is already widely available and prescribed for [a] 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.”

Commenting on the study, Paul Forsyth, cardiology consultant pharmacist at NHS Golden Jubilee National Hospital in Clydebank, Scotland, said: “We have known about the positive benefit of Ezetimibe added to statin therapy following myocardial infarction for around a decade, following the IMPROVE-IT trial.

“The benefits centre around reduction in further non-fatal ischemic events (e.g. MIs [myocardial infarctions] and strokes), but not in mortality. Although interesting, we need to cautiously interpret additional observational data, as it is much more influenced by bias, and it is virtually impossible to fully correct for this.

“While reducing LDL-C [low-density lipoprotein cholesterol] is an important therapeutic goal for clinicians treating patients after MI, we likely need a holistic approach that considers patient treatment goals, competing long-term risks and cost effectiveness.

“Ezetimibe is a key therapeutic option when additional LDL-C lowering is judged to the correct strategy for an individual patient. Pharmacists in all settings of care are well-placed to help review these care issues with patients.”