Article Impact Level: HIGH Data Quality: STRONG Summary of Journal of the American College of Cardiology, 85(15), 1550–1564. https://doi.org/10.1016/j.jacc.2025.02.007 Dr. Margret Leosdottir et al.
Points
- The study used data from the SWEDEHEART registry to assess whether early or late initiation of combination lipid-lowering therapy (LLT) with statins and ezetimibe after myocardial infarction (MI) leads to better cardiovascular outcomes.
- Early combination therapy was associated with the lowest risk of major adverse cardiovascular events (MACE), showing a 1.79 per 100 patient-years incidence at 1 year compared to 2.58 for late therapy and 4.03 for statin-only.
- The weighted risk differences for MACE compared to early combination therapy were 0.6% at 1 year and 1.1% at 2 years for the late therapy group, suggesting early treatment significantly reduces cardiovascular risks.
- Early combination therapy showed lower cardiovascular death rates, with hazard ratios indicating significantly worse outcomes for those receiving delayed therapy or statin monotherapy, highlighting the importance of early treatment.
- The findings support the use of early combination therapy as standard practice for MI care. It shows substantial benefits in reducing long-term cardiovascular risks compared to delayed or statin-only treatment approaches.
Summary
This study aimed to assess whether early or late initiation of combination lipid-lowering therapy (LLT) with statins and ezetimibe after myocardial infarction (MI) results in better cardiovascular outcomes. Using data from the SWEDEHEART registry, 35,826 MI patients were analyzed, with a median age of 65.1 years and 26% female. Patients were categorized into three groups: those who received early combination therapy (ezetimibe added within 12 weeks), late combination therapy (added between 13 weeks and 16 months), and those who received statins alone. The study tracked major adverse cardiovascular events (MACE), including death, MI, and stroke, over a median follow-up of 3.96 years.
The results indicated that early combination therapy was associated with the lowest risk of MACE compared to the late combination or statin-only groups. At 1 year, MACE incidences were 1.79 per 100 patient-years in the early therapy group, 2.58 in the late therapy group, and 4.03 in the statin-only group. The weighted risk differences for MACE compared to early combination therapy were 0.6% (95% CI, 0.1%-1.1%; P < 0.01) at 1 year and 1.1% (95% CI, 0.3%-2.0%; P < 0.01) at 2 years for the late group. For those receiving no ezetimibe, the risk difference was 0.7% (95% CI, 0.2%-1.3%) at 1 year, with the 3-year hazard ratio (HR) of 1.29 (95% CI: 1.12-1.55).
The findings support the implementation of early combination therapy with statins and ezetimibe as standard practice for MI care. Delaying the use of combination therapy or relying solely on high-intensity statin monotherapy resulted in significantly worse outcomes, including higher rates of cardiovascular death (HR for late therapy: 1.64, 95% CI: 1.15-2.63; for no therapy: 1.83, 95% CI: 1.35-2.69). These results suggest that early initiation of combination therapy offers substantial benefits in reducing long-term cardiovascular risks.
Link to the article: https://www.sciencedirect.com/science/article/pii/S0735109725003596
References Leosdottir, M., Schubert, J., Brandts, J., Gustafsson, S., Cars, T., Sundström, J., Jernberg, T., Ray, K. K., & Hagström, E. (2025). Early ezetimibe initiation after myocardial infarction protects against later cardiovascular outcomes in the swedeheart registry. Journal of the American College of Cardiology, 85(15), 1550–1564. https://doi.org/10.1016/j.jacc.2025.02.007
