Two common drugs taken together ‘slash your risk of dying from heart attack and stroke’
TAKING two common drugs together could slash your levels of ‘bad’ cholesterol and lower the risk of death from heart attack and stroke, a study showed.
This method of treating high cholesterol could prevent thousands of deaths a year from heart attacks, strokes and other cardiovascular diseases, researchers said.
High cholesterol is when you have too much much of a fatty substance in your blood.
Not taking steps to lower it can narrow your blood vessels and increase your risk of heart attack and stroke.
People with high cholesterol will often be prescribed a medication called a statin, and told to exercise more and eat less saturated fat.
But researchers suggested that taking statins in combination with a second cholesterol-lowering drug called ezetimibe is more effective in bringing down levels of ‘bad’ cholesterol in the blood – also known as non-high-density lipoproteins (HDL).
Ezetimibe – sold under the brand name Ezetrol – is used to bring down high blood cholesterol and may be prescribed to people who can’t take statins, or saw no change from them.
But researchers found that taking the two pills in tandem reduced LDL cholesterol levels by an extra 13mg per decilitre (dL) of blood compared to statins alone.
This increased the chances of reaching the ideal blood cholesterol levels of less than 70mg/dL of LDL-C by 85 per cent.
Combining a high dose of statins with ezetimibe could also slash high cholesterol sufferer’s risk of death, researchers added.
Their study, published in the journal Mayo Clinic Proceedings, showed that the drug duo slashed participants’ risk of death from any cause by 19 per cent, compared to high doses of statins alone.
It also reduced the risk of death from cardiovascular diseases by 16 per cent, and lowered the risk of heart attack or stroke by 18 per cent and 17 per cent respectively.
Maciej Banach, first author of the study and cardiology professor at the John Paul II Catholic University of Lublin, Poland, said: “These results were even more pronounced in the network meta-analysis, which enables a direct comparison of different therapy regimens used in the study.
“This showed a 49 per cent reduction in all-cause mortality and a 39 per cent reduction in major adverse cardiovascular events, when compared to high dose statin therapy alone.”
Taking statins and ezetimibe together is “safe and efficacious”, Prof Banach added.
Researchers analysed a total of 14 studies, which included 108,373 patients with high cholesterol who were at risk of heart disease and stroke.
Subtle signs of a heart attack
A HEART attack is when the supply of the blood to the heart is suddenly blocked.
It is a medical emergency and needs to be treated right away.
Around 100,000 people are admitted to hospital due to heart attacks every year in the UK, according to the British Heart Foundation.
That’s 290 each day, or one every five minutes.
Some symptoms, like chest pain, shortness of breath and feeling lightheaded or dizzy, can be fairly obvious.
But the signs aren’t always so blatant, the NHS warns. Other more subtle symptoms of a heart attack include:
- Pain in other parts of the body (it can feel as if the pain is spreading from your chest to your arms, jaw, neck, back and stomach)
- Sweating
- Feeling sick
- Vomiting
- An overwhelming feeling of anxiety (similar to a panic attack)
- Weakness or fatigue
- Coughing
- Wheezing
A heart attack and cardiac arrest are similar, but not the same.
A cardiac arrest is when the heart stops pumping blood around the body.
Statins help to lower LDL cholesterol by reducing the production of it by the liver.
Ezetimibe reduces the amount of cholesterol that the body takes from food by stopping its absorption in the intestines.
Some patients don’t respond to statins and are prescribed ezetimibe in combination with a statin.
Until now, there have been inconsistent findings about whether the drug combo should be given to high-risk patients immediately, even before they suffer a heart attack or stroke, or whether doctors should start them on a high dose of statins first and monitor their cholesterol levels for at least two months, before deciding if they need ezetimibe as well.
Study co-author Peter Toth, from the University of Illinois, said: “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.
“Simply adding ezetimibe to statin therapy, without waiting for at least two months to see the effects of statin monotherapy, which is suboptimal in many patients, is associated with more effective LDL-cholesterol goal achievement and is responsible for significant incremental reductions in cardiovascular health problems and deaths.
“This approach does not require additional funding or reimbursement of new expensive drugs.
“In fact, it may translate into lower rates of first and subsequent heart attacks and stroke, and their complications like heart failure, which are extremely costly for all healthcare systems.
“Our findings underline the importance of the adages ‘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.”
Prof Banach added: “Cardiovascular disease kills around 20 million people a year worldwide.
“We estimate that if combination therapy to reduce LDL cholesterol 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.”
It comes after research showed that over half of Brits are battling dangerously high cholesterol levels without knowing.
High cholesterol doesn’t usually cause symptoms so many won’t realise they have it until it’s too late.
You can get your cholesterol levels checked through a blood test.
If you’re over 40, you may have a test during your NHS Health Check – you can also get this check at a pharmacy.
What you need to know about cholesterol
Cholesterol is used by all the cells in your body to keep them healthy.
It is carried around your body to the cells that need it by proteins in your blood.
Proteins are substances in your body that do most of the work in your cells and help keep your body’s tissues and organs working as they should.
When cholesterol and proteins combine, they’re called lipoproteins. There are two types of these, one good and one bad.
High-density lipoproteins or HDL is known as ‘good’ cholesterol.
It gets rid of the ‘bad’ cholesterol from your blood by taking cholesterol you don’t need back to the liver, where it is broken down and removed from your body.
Non-high-density lipoproteins or non-HDL is known as ‘bad’ cholesterol.
Too much non-HDL leads to a build up of fatty deposits inside the walls of the blood vessels. This builds up and narrows blood vessels, increasing the risk of a heart attack or stroke.
You may also have heard ‘bad’ cholesterol being called ‘LDL’ cholesterol.
What’s a healthy cholesterol reading?
- Total cholesterol: below 5mmol/L
- HDL: Above 1.0mmol/L for men or above 1.2mmol/L for women
- Non-HDL: Below 4mmol/L
Sources: BHF, NHS