Heart disease remains the leading cause of death in the United States, claiming approximately 700,000 American lives each year. Now, groundbreaking research suggests that a simple change in cholesterol-lowering treatment could prevent nearly 50,000 deaths annually.
The power of combination therapy
A study published Sunday in Mayo Clinic Proceedings advocates for an immediate shift in how high-risk patients are treated. Researchers found that using a combination of statins—drugs that reduce cholesterol production in the liver—and ezetimibe, which blocks cholesterol absorption in the small intestine, can significantly lower the risk of cardiovascular events.
“The combination therapy is safe and efficacious,” said first study author Maciej Banach, a professor of cardiology at the John Paul II Catholic University of Lublin, Poland.
Traditionally, patients at high risk for heart attack or stroke are prescribed statins alone, with ezetimibe being added only if cholesterol levels remain elevated after a two-month evaluation period. However, Banach’s analysis of 14 studies, encompassing more than 108,000 patients with blocked arteries, challenges this approach.
The findings suggest that initiating combination therapy immediately can reduce the risk of early death by 19%, a major cardiovascular event by 18%, and stroke by 17%.
A potential new gold standard
“This study confirms that combined cholesterol-lowering therapy should be considered immediately and should be the gold standard for treatment of very high-risk patients,” said study co-author Peter Toth.
Toth emphasized that waiting to see the effects of statins alone is unnecessary and could lead to suboptimal outcomes for many patients. “Simply adding ezetimibe to statin therapy without waiting for at least two months is associated with more effective LDL [cholesterol] goal achievement and significant incremental reductions in cardiovascular health problems and deaths.”
Globally, cardiovascular disease claims around 20 million lives each year, fueled by risk factors such as high blood pressure, smoking, obesity, physical inactivity, diabetes, and high cholesterol. In the U.S. alone, nearly 94 million adults have what could be considered borderline high cholesterol.
A cost-effective solution
Unlike some newer, costly cholesterol-lowering treatments, ezetimibe and statins are both widely available and relatively inexpensive. “This approach does not require additional funding or reimbursement of new expensive drugs,” Toth noted. “In fact, it may translate into lower rates of first and subsequent heart attacks and strokes and their complications like heart failure, which are extremely costly for all healthcare systems.”
Dr. Benjamin Hirsh, director of preventive cardiology at North Shore University Hospital, echoed these findings, emphasizing the urgency of aggressive cholesterol management.
“It is very important that patients and physicians, in particular, realize that aggressive reduction of LDL cholesterol is paramount, particularly for the highest-risk patients,” Hirsh told The Post. “Physicians often take a ‘wait and see’ approach to see how patients initially respond to statin therapy. For very high-risk patients, there is no reason to wait.”
With mounting evidence in favor of immediate combination therapy, experts hope this research will push healthcare providers to adopt a more proactive approach in cholesterol management—potentially saving tens of thousands of lives each year.
