According to a major new study released on Monday Mayo Clinic Procedure.
This finding challenges current medical practice, suggesting that doctors should not wait for statins to work alone before adding a second drug to high-risk patients with artery blockage.
The researchers found that immediately combining statins with a drug called ezetimibe reduced the overall risk of death by 19% compared to patients who treated high-dose tinoids alone. The combination also reduced the number of deaths from cardiovascular causes by 16%, and reduced the occurrence of major cardiac events and stroke by 18% and 17%, respectively.
“This study confirms that cholesterol-lowering therapy should be considered immediately and should be the gold standard for very high-risk patients after an acute cardiovascular event,” said Peter Toth, a professor of clinical family and community medicine in Illinois.
The largest research in this category
The meta-analysis examined 108,353 patients in 14 studies, making it the most comprehensive study of similar studies. All participants were at high risk of heart attack or stroke or had experienced one of the events.
Currently, many doctors start using high-risk patients on statins first and monitor cholesterol levels at least two months before considering other drugs. Researchers believe this approach misses a critical window for prevention.
The results were even more astonishing when the researchers conducted a network meta-analysis (capable of direct comparisons between different treatments). This indicated a 49% reduction in deaths for all causes compared to statins alone, and a 39% reduction in significant adverse cardiovascular events in combination with statins.
“The effects of tins monotherapy can be seen only by adding ezetimibe to statin therapy without waiting for at least two months, which is suboptimal in many patients, associated with more effective LDL-C target achievement and responsible for a significant reduction in cardiovascular health problems and death,” Toth explained.
How it works
Statins reduce “undessential” cholesterol (LDL-C) by limiting their production in the liver, and ezetimibe works differently – it blocks cholesterol absorption in the intestine. The dual method reduces cholesterol levels significantly lower than those of statins, reducing LDL-C by 13 mg per broken blood.
This increases the chances of patients reaching the ideal goal of LDL-C below 70 mg/dl.
Importantly, the study found that patients endured combined treatment just as well as statins. In fact, online meta-analysis showed that the treatment rate of combined approaches and high-dose statins was significantly reduced by 44%.
Global Impact
Cardiovascular disease remains the world’s leading killer, with about 20 million lives each year. The highest mortality rate in Eastern Europe and Central Asia is attributed to an increase in LDL-C, with 4.5 million deaths worldwide associated with high cholesterol in 2020.
“Based on our previous analysis, we estimate that if all treatment guidelines for combining therapy to reduce LDL-C are included in physicians everywhere and are implemented for patients with high cholesterol levels, it will prevent more than 330,000 deaths per year in patients who have suffered heart attacks, nearly 50,000 deaths in the United States alone, and 50,000 deaths in the United States alone.
Banach also serves as an adjunct professor at the Ciccarone Center for Prevention of Cardiovascular Diseases at Johns Hopkins University, hosting the international team for the analysis.
Cost-effective approach
Unlike many medical advances that require a lot of new investment, this approach can actually reduce medical costs.
“This approach does not require additional funding or reimbursement of new expensive drugs. In fact, it may translate into a lower rate of first and later heart attacks and strokes, as well as their complications (such as heart failure), which are very expensive for all healthcare systems,” Toth notes.
The researchers believe that these findings highlight two key principles in cardiovascular care: “longer longer” and “early the earlier, the earlier” when treating high-risk patients.
“We recommend that combination therapy should be considered as the golden standard of treatment for these patients and are included in all future treatment guidelines,” Banach concluded.
If you find this report useful, consider supporting our work with a small donation. Your contribution allows us to continue to bring you accurate, thought-provoking scientific and medical news that you can trust. Independent reporting requires time, effort, and resources, and your support makes it possible for us to continue exploring stories that are important to you. Together, we can ensure that important discoveries and developments attract those who need them the most!
