Intensive Lipid Reduction After Heart Attack Saves Lives

A recent study highlights the critical benefits of early lipid-lowering therapy for patients recovering from a heart attack. Research conducted on a substantial cohort of 35,826 patients within the Swedish SWEDEHEART registry showcases the advantages of initiating a combination therapy involving ezetimibe and statins promptly after a myocardial infarction.

Led by a team from the Department of Cardiology at Skåne University Hospital in Malmö, Sweden, the study aimed to determine the impact of early versus delayed prescription of lipid-lowering medications on cardiovascular outcomes, specifically major adverse cardiovascular events (MACE), which include death, non-fatal myocardial infarction, and stroke.

Patients were divided into three groups: one receiving early combination therapy, another undergoing delayed therapy initiation, and a third group treated solely with statins. The primary endpoints evaluated were MACE occurrences and cardiovascular mortality over an average follow-up period of approximately 3.96 years.

The findings revealed that only 17% of patients in the early therapy group and 18% in the delayed group received the combination therapy, resulting in the majority (65%) being treated with statin monotherapy.

Notably, the one-year MACE rate was significantly lower in the early therapy group at 1.79 per 100 patient-years, compared to 2.58 in the delayed therapy group and 4.03 for those on statin monotherapy. The analysis also showed that the three-year hazard ratios for MACE were 1.14 for those starting the combination therapy late and 1.29 for patients on statins alone.

Additionally, the early combination therapy group achieved target LDL cholesterol levels (<1.4 mmol/L and >= 50% reduction) more frequently, with 55% meeting these goals, compared to only 28% in the delayed group and 25% in the statin-only cohort.

In light of these results, the researchers advocate for a shift away from a stepwise approach to lipid reduction following a heart attack. They propose implementing a proactive strategy, prescribing combination therapy before patient discharge to enhance the likelihood of achieving target lipid levels and significantly lowering the risk of cardiovascular events.