The 12-Week Lifeline: A Fast-Acting Drug Combo That Could Stop Your Next Heart Attack

A major new study shows that giving heart attack patients a cholesterol-lowering combo treatment early on – not months later – can dramatically improve their outlook and even save lives.

Patients treated within 12 weeks using both statins and ezetimibe were significantly less likely to suffer future heart attacks or die, compared to those treated later or not at all. Backed by real-world data from over 36,000 patients, researchers say the current “wait and see” approach is outdated, and simple, cost-effective changes to guidelines could prevent thousands of heart attacks each year.

Early Combination Treatment Boosts Recovery After Heart Attacks

Patients who start an additional cholesterol-lowering medication soon after a heart attack have significantly better outcomes than those who receive it later, or not at all.

That’s the finding from a new study led by researchers at Lund University in Sweden and Imperial College London. Their results suggest that treating heart attack patients early with a combination of statins and the cholesterol-lowering drug ezetimibe could prevent thousands of future heart attacks over the next decade.

Heart Attacks Still Lead Global Mortality

Cardiovascular disease remains the leading cause of death worldwide, with heart attacks (also called myocardial infarctions) being the most common and dangerous events. For survivors, the risk of another heart attack is highest in the first year, when blood vessels are still highly sensitive and more prone to developing clots.

Lowering LDL, or “bad,” cholesterol can help stabilize the arteries and reduce the likelihood of another cardiac event. Current guidelines recommend starting patients on high-potency statins right after a heart attack. But many patients don’t reach the target cholesterol levels with statins alone, and need an additional drug like ezetimibe.

Current Guidelines May Be Too Slow

“Today’s guidelines recommend stepwise addition of lipid-lowering treatment. But it’s often the case that this escalation takes too long, it’s ineffective and patients are lost to follow-up,” says Margrét Leósdóttir, Associate Professor at Lund University and senior cardiology consultant at Skåne University Hospital in Malmö, Sweden. “By giving patients a combination treatment earlier, we could help to prevent many more heart attacks.”

Co-investigator 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’s 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.”

Large-Scale Data Confirms Early Treatment Advantage

In the latest study, the international team examined outcomes for heart attack patients if they received a combination of statins with the add-on therapy ezetimibe (within 12 weeks after a heart attack), statins with ezetimibe added later (between 13 weeks and 16 months), or just statins with no ezetimibe at all.

Based on Swedish registry data from 36,000 patients who had a heart attack between 2015 and 2022, the researchers used advanced statistical models to emulate a clinical trial. The results show that patients who received a combination treatment of statins and ezetimibe within 12 weeks of a heart attack and were able to lower cholesterol to the target level early, had a better prognosis and less risk of new cardiovascular events and death than those who received the add-on treatment later, or not at all.

Thousands of Heart Attacks Could Be Prevented

From the analysis, the researchers believe many new heart attacks, strokes, and deaths could be prevented every year internationally if the treatment strategy were to be changed. Under a scenario in which 100% of patients would receive ezetimibe early, they estimate 133 heart attacks could be avoided in a population of 10,000 patients in 3 years.

The researchers suggest that in the UK, which records an estimated 100,000 hospital admissions from heart attacks a year,^[1] this would equate to an estimated 5,000 heart attacks being prevented over a ten year period.^[2]

Early Combo Therapy: Safe, Cheap, Effective

Dr. Leósdóttir 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 overmedication. However, there are positive effects from applying both medicines as soon after the infarction as possible. Not doing this entails an increased risk. In addition, the drug we have examined in the study causes few side effects and is readily available and inexpensive in many countries.”

Margrét Leósdóttir hopes that the research results will in time provide support for changes in the recommendations. A treatment algorithm has already been introduced at her hospital in Sweden to help doctors to prescribe appropriate lipid-lowering treatment for patients who have had a myocardial infarction. It has been noted that patients achieve their treatment goals earlier and two months after the infarction twice as many patients have reduced their bad cholesterol to the target level, compared with previously.

A Scalable Model for Global Impact

“Several other hospitals in Sweden have also adopted the algorithm and there are similar examples from other countries that have produced as good results. My hope is that even more will review their procedures, so that more patients will get the right treatment in time, and we can thereby prevent unnecessary suffering and save lives.”

Professor Ray added: “Our findings suggest that a simple change in treatment guidelines could have a huge impact on patients and reduce the demand on the NHS. 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.”

Notes

1. British Heart Foundation UK Factsheet January 2025 (Pg 8). ‘In the UK around 100,000 hospital admissions each year are due to heart attacks’ https://www.bhf.org.uk/-/media/files/for-professionals/research/heart-statistics/bhf-cvd-statistics-uk-factsheet.pdf
2. An estimated 5000 heart attacks could be prevented over a ten-year period. This is based on 100% of a population of 100,000 patients receiving ezetimibe add-on early, preventing 1331 Major Adverse Cardiovascular Events (MACE) over three years. This translates to an estimated 4,437 MACE avoided over a ten-year period.

Reference: “Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry” by Margret Leosdottir, Jessica Schubert, Julia Brandts, Stefan Gustafsson, Thomas Cars, Johan Sundström, Tomas Jernberg, Kausik K. Ray and Emil Hagström, 14 April 2025, Journal of the American College of Cardiology.
DOI: 10.1016/j.jacc.2025.02.007

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