Thousands of heart attacks could be prevented if the NHS started quickly prescribing a drug in combination with statins, new research suggests. Scientists are demanding a change to NHS prescribing guidelines after discovering how effective statins are alongside the cholesterol-lowering drug ezetimibe – if prescribed early enough.
The research team including Imperial College London academics tracked 36,000 patients who had a heart attack between 2015 and 2022. Having a heart attack significantly increases the risk of having another one. One in five people who have had a heart attack are readmitted to the hospital for a second heart attack within five years.
The study showed those who got both statins and ezetimibe within 12 weeks of their heart attack had lower risk of new cardiovascular events – such as heart attacks or strokes – than those who received the combination between 13 weeks and 16 months, or who got just statins.
The scientists calculated that if all patients had received ezetimibe early then 133 heart attacks could be avoided for every 10,000 patients over three years. There are 100,000 hospital admissions from heart attacks every year in the UK so an estimated 5,000 heart attacks could be prevented over a 10-year period, researchers said.
Author Professor Kausik Ray, from Imperial College London’s School of Public Health, said: “This study shows that we could save lives and reduce further heart attacks by giving patients a combination of two low-cost drugs. But 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.”
Every year over 40,000 people die early due to a heart attack or other cardiovascular condition in Britain.
UK scientists collaborated on the study with colleagues from Lund University in Sweden using medical data from its national health registry along with advanced statistical models to emulate a clinical trial.
Patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack were able to lower cholesterol to the target level earlier and had a lower risk of death.
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.”
Patients are at the greatest risk of suffering a new heart attack in the first year after the first one because the blood vessels are more sensitive and it is easier for blood clots to develop.
Researcher Margret Leosdottir, Lund University associate professor and senior cardiology consultant at Skane University Hospital in Malmo, Sweden, 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. The drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”
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