Baltimore, MD—Immediately prescribing a combination of cholesterol-lowering drugs with statins and ezetimibe to patients with ACS could substantially decrease their risk of death.

The research published in the Journal of the American Heart Association reported that ACS patients—including those who have experienced a heart attack or unstable angina—are 47% less likely to die within 3 years if they begin that drug regimen compared with only a high-dose statin.

The study was led by Maciej Banach, MD, PhD, professor of Cardiology at the Medical University of Lodz, Poland, and adjunct professor at the Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine in Baltimore.

“Patients with acute coronary syndrome, such as those who have already had a heart attack, face a much higher risk of further heart problems. Current guidelines, including those on prevention from the European Society of Cardiology, recommend a stepwise approach, first offering a statin only,” Dr. Banach said. “This study shows that if we act quickly and decisively to lower patients’ cholesterol with this combination of treatments, we can drastically reduce the risk of death.”

The study team sought to compare statin monotherapy and upfront combination therapy of statin and ezetimibe in patients with ACS and included consecutive patients in the PL-ACS (Polish Registry of Acute Coronary Syndromes), which is a national, multicenter, ongoing, prospective observational registry that is mandatory for patients with ACS hospitalized in Poland.

After propensity score matching, researchers analyzed two groups: 768 patients with statin monotherapy (atorvastatin or rosuvastatin) and 768 receiving an upfront combination therapy of statin and ezetimibe. “The difference in mortality between groups was significant during the follow-up and was present at 1 (5.9% versus 3.5%; P = 0.041), 2 (7.8% versus 4.3%; P = 0.019), and 3 (10.2% versus 5.5%; P = 0.024) years of follow-up in favor of the upfront combination therapy, as well as for the overall period,” the study reported.

“For the treatment, rosuvastatin significantly improved prognosis compared with atorvastatin (odds ratio [OR], 0.790 [95% CI, 0.732-0.853]),” the authors added. “Upfront combination therapy was associated with a significant reduction of all-cause mortality in comparison with statin monotherapy (OR, 0.526 [95% CI, 0.378-0.733]), with an absolute risk reduction of 4.7% after 3 years (number needed to treat = 21).”

The researchers concluded that upfront combination lipid-lowering therapy is superior to statin monotherapy for all-cause mortality in patients with ACS. “These results suggest that in high-risk patients, such an approach, rather than a stepwise therapy approach, should be recommended,” they advised.

The risk of death was found to be lower after only 52 days of treatment, with the results suggesting that out of every 21 patients taking the double treatment for 3 years, one death was prevented.

“Around seven million people suffer acute coronary syndrome every year and the majority of cases are linked to high cholesterol and a build-up of fat in the blood vessels,” Dr. Banach noted. “We have effective cholesterol-lowering treatments, but we must make sure the people who need them are taking them.”

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