Administering a cholesterol-lowering combination therapy shortly after a heart attack significantly improves patient outcomes, according to new research from Lund University in Sweden and Imperial College London.
The study suggests that early treatment with both statins and ezetimibe—rather than delaying or omitting the add-on drug—could prevent thousands of recurrent heart attacks over the next decade.
Cardiovascular disease remains the leading cause of death globally, with heart attacks being the most frequent acute event. Patients who survive an initial heart attack are at greatest risk of a second event within the first year, as blood vessels remain vulnerable and prone to clot formation.
Lowering levels of LDL cholesterol is crucial for stabilising these vessels and preventing further cardiovascular incidents. Current treatment guidelines recommend initiating high-potency statins immediately after a heart attack. However, many patients fail to reach the target cholesterol levels on statins alone and require additional medication—such as ezetimibe.
Guidelines currently suggest a stepwise approach to lipid-lowering therapy, but that process is often too slow, and many patients are lost to follow-up. Starting combination therapy early could prevent many more heart attacks.
The study analysed data from 36,000 Swedish patients who suffered heart attacks between 2015 and 2022. Using advanced statistical modelling to emulate a clinical trial, researchers compared three groups: those who received statins plus ezetimibe within 12 weeks, those who received the combination later (between 13 weeks and 16 months), and those who received statins alone.
Patients who began combination therapy within 12 weeks had significantly better outcomes, with reduced risk of subsequent cardiovascular events and death. Researchers estimate that initiating ezetimibe early in all patients could prevent 133 heart attacks per 10,000 people over three years.
In the U.K. —where approximately 100,000 people are hospitalised for heart attacks annually—this could translate to about 5,000 prevented heart attacks over a decade.
Study researchers point out that early combination therapy is underutilised for two key reasons: current guidelines don’t universally endorse it, and clinicians may hesitate due to concerns about overmedication. But the drug is well tolerated, inexpensive, and widely available. Delaying its use increases risk.
These findings point to a clear opportunity. Ezetimibe is low-cost—about £350 annually per patient—and widely available. Updating treatment guidelines could ease pressure on healthcare systems and, more importantly, save lives.
Source: Imperial College London
Image Credit: iStock
References:
Lesodottir M, Schubert J, Brandts J 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.
