Combining two common ‘low cost’ drugs could prevent thousands of heart attacks, strokes and deaths, scientists say
THOUSANDS of heart attacks and strokes could be prevented with a combination of two drugs, a new study suggests.
Patients who were given statins as well as ezetimibe within 12 weeks of a heart attack had better prognosis.
They were able to lower cholesterol faster and were at less risk of a new cardiovascular events or death than those who received the add-on ezetimibe between 13 weeks and 16 months, or not at all, according to the study.
Professor Kausik Ray, from Imperial College London’s School of Public Health, said: “At the moment patients across the world aren’t receiving these drugs together.
“That is causing unnecessary and avoidable heart attacks and deaths – and also places unnecessary costs on healthcare systems.
“Our study shows the way forward.
“Care pathways must now change for patients after this type of heart event.”
The study included data from 36,000 patients in Sweden who had a heart attack between 2015 and 2022.
Patients are most at risk of a second heart attack a year after the first but statins help by reducing ‘bad’ cholesterol, also known as non-high-density lipoproteins (HDL).
The team estimate 133 heart attacks could be avoided per 10,000 patients in three years if ezetimibe was prescribed early.
This would equate to an estimated 5,000 heart attacks being prevented in the UK over 10 years, they suggest.
That’s based on the fact that 100,000 people are admitted to hospital with a heart attack each year.
The team did not give an estimation for how many strokes – also called a cardiovascular event – may be prevented.
Professor Ray said: “Ezetimibe is already widely available and prescribed for 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.”
Researcher Margret Leosdottir, Lund University associate professor and senior cardiology consultant at Skane University Hospital in Malmo, Sweden, welcomed the results, saying that “by giving patients a combination treatment earlier, we could help to prevent many more heart attacks”.
But she said there are reasons why medics are cautious about combination therapy.
She said: “Combination therapy is not applied up-front for two main reasons.
“General recommendations are not included in today’s guidelines and a precautionary principle is applied to avoid side effects and over-medication.
“However, there are positive effects from applying both medicines as soon after the infarction as possible.
“Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”
The findings are published in the Journal of the American College of Cardiology (JACC) today.
It comes after a separate study by researchers in Poland found the same findings last month – that taking statins in tandem with ezatimibe 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 of any cause by up to 19 per cent, findings published in the journal Mayo Clinic Proceedings showed.
What are statins?
Statins are daily medicines that can help lower the level of low-density lipoprotein cholesterol – often referred to as “bad cholesterol – in the blood.
Having a high level of LDL cholesterol can be dangerous, as it can lead to atherosclerosis and cardiovascular disease.
Statin tablets are meant to be taken once a day.
Your dose will depend on why you need the medicine, your cholesterol levels, and other medicines you’re taking.
The drugs sometimes interact with other medicines and foods. like grapefruit juice.
These interactions may sometime result in serious side effects like muscle damage.
What are the side effects of statins?
Most people don’t have any side effects from taking statins.
But some people may experience the following:
- Headache
- Dizziness
- Feeling sick
- Feeling unusually tired or physically weak
- Digestive system problems, such as constipation, diarrhoea, indigestion or farting
- Muscle pain
- Sleep problems
- Low blood platelet count
Some uncommon side effects include:
- Being sick
- Memory problems
- Hair loss
- Pins and needles
- Inflammation of the liver (hepatitis), which can cause flu-like symptoms
- Inflammation of the pancreas (pancreatitis), which can cause stomach pain
- Skin problems, such as acne or an itchy red rash
- Sexual problems, such as loss of libido (reduced sex drive) or erectile dysfunction
Rarely, people experience muscle weakness, loss of sensation or tingling in the nerve endings of the hands and feet and tendon problems.
It’s rare, but statins can also sometimes cause muscle inflammation and damage.
Speak to your doctor if you have muscle pain, tenderness or weakness that cannot be explained – for example, pain that is not caused by physical work.
If you are having problems with side effects, talk to the doctor in charge of your care.
Your dose may need to be adjusted or you may need a different type of statin.
Source: NHS