Double drug therapy reduces mortality in acute coronary syndrome

Investigators report that patients suffering ACS/acute coronary syndrome (heart attack or unstable angina), are less likely to die within three years if they begin immediate treatment with a high dose statin plus ezetimibe, compared to patients who only get a statin.

The finding were published on Sept. 6, 2023 in the Journal of the American Heart Association.

Lead investigator 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, Baltimore, USA, said, “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. 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 used data on consecutive patients with ACS included in a mandatory hospital registry in Poland.

Two subgroups were analyzed and compared in this study, those receiving statin monotherapy (atorvastatin or rosuvastatin; n=768) or combination therapy of a statin and ezetimibe (n=768).

The difference in mortality between the statin monotherapy and combination therapy groups was significant throughout the follow-up. It appeared at year 1 (5.9% versus 3.5%; P=0.041), year 2 (7.8% versus 4.3%; P=0.019) and year 3 (10.2% versus 5.5%; P=0.024), with an absolute risk reduction of 4.7% after 3 years.

The results indicate that for every 21 patients on the double treatment for three years, one death was prevented.

The authors noted that ACS affects about seven million people worldwide, including around four million heart attack patients. They said that double drug therapy for ACS could prevent an estimated 330,000 deaths per year.

They concluded, “The 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, only such an approach, and not a stepwise therapy approach, should be recommended.”