Affordable Medication Mix May Lower Chance of Repeat Heart Attacks, Strokes

Researchers analyzed data from over 35,000 heart attack patients who were admitted between 2015 and 2022 and recorded in the SWEDEHEART registry in Sweden.

Most were prescribed high-intensity statins upon discharge, but a portion also began treatment with ezetimibe within the first 12 weeks following their discharge.

The patients were divided into three categories: those who commenced ezetimibe treatment early (within 12 weeks), those who started late (between 13 weeks and 16 months after discharge), and those who did not receive ezetimibe during the study period.

The study utilized advanced statistical techniques to mimic a randomized clinical trial, thus reducing potential biases.

Findings revealed that the early introduction of ezetimibe along with statins significantly decreased the risk of major adverse cardiovascular events (MACE), which includes death, further heart attacks, or strokes, compared to those who started ezetimibe later or not at all.

The occurrence of MACE over one year was 1.79 per 100 patient-years in the group that started ezetimibe early, versus 2.58 in the late starters, and 4.03 in those who did not receive ezetimibe.

At three years, the risk ratios for MACE were 1.14 for late versus early treatment (statistically insignificant) and 1.29 for no treatment versus early treatment, showing a significantly higher risk without ezetimibe.

Furthermore, cardiovascular mortality rates were notably higher in the groups that started late or did not receive ezetimibe compared to those treated early.

The study also highlighted that early combination therapy significantly increased the number of patients achieving the recommended LDL cholesterol targets.

The research emphasizes that a sequential approach of using statins followed by ezetimibe only if needed leads to delays in achieving optimal cholesterol reduction, resulting in preventable health risks.

According to the authors, around 75-80% of patients do not meet the LDL cholesterol targets with just statin therapy; therefore, initiating combination therapy early can enhance outcomes and minimize future cardiovascular incidents.

The researchers recommend updating care pathways for heart attack patients to include the combination of statins and ezetimibe as standard care, possibly before even leaving the hospital.

Arun Manmadhan, MD, an assistant professor of cardiology at Columbia University Irving Medical Center who was not involved with the study, noted that the findings are consistent with extensive research indicating that maintaining low LDL cholesterol levels results in fewer heart attacks and strokes.

“This is particularly crucial for individuals who have already suffered one of these events,” he mentioned, “because managing cholesterol levels, along with other cardiac risk factors, is among the most effective strategies to prevent a recurrence.”

Manmadhan added, “The study suggests that the timing of cholesterol management is also critical. The earlier and more aggressively cholesterol levels are controlled to within recommended limits after a heart attack, the better the outcomes in preventing future cardiovascular issues.”

Markyia Nichols, MD, MPH, RDN, a certified lifestyle coach and Chief Medical Officer at Ciba Health, mentioned that patients should understand that cholesterol itself is not the problem.

“Cholesterol is a necessary component of life. It is vital for producing hormones, stabilizing cell membranes, and repairing tissues. If cholesterol levels are increasing, it’s essential to consider what the body is attempting to repair or defend against,” she explained.

Nichols pointed out that the real issue is inflammation, not cholesterol. Factors such as a diet rich in sugars, processed oils, and ultra-processed foods, along with insulin resistance, metabolic dysfunction, chronic stress, and toxin exposure, can all contribute to inflammation.

“When the heart lining is damaged, cholesterol is sent to act as a patch,” she stated. “Cholesterol doesn’t start the ‘fire’ but rather acts like the ‘firefighters’.”

She also noted that LDL becomes a problem only when it is oxidized, which can happen due to poor nutrition.

Referencing the study, Nichols remarked that while adding ezetimibe to statins post-heart attack can lower cholesterol, it does not address the fundamental causes of the issue. Patients should also focus on improving their nutrition.

“Request lab tests that measure levels of magnesium, omega-3s, vitamin D, and vitamin K2,” she advised. “A healthy heart cannot be rebuilt without the proper raw materials.”

She also recommended checking for markers of inflammation such as C-reactive protein, homocysteine, and insulin, and identifying any potential sources of inflammation like poor diet, stress, toxins, or an unhealthy gut.

Nichols concluded by suggesting that patients might need to consult with a board-certified doctor trained in root-cause medicine to determine the underlying causes of their inflammation.

Addressing these underlying issues can aid in treating the root causes of elevated cholesterol levels.