Early Combination of Lipid-Lowering Therapy Beneficial After Myocardial Infarction
MONDAY, April 28, 2025 -- For patients with myocardial infarction (MI), early oral combination lipid-lowering therapy (LLT) is beneficial, according to a study published online in the April 22 issue of the Journal of the American College of Cardiology.
Margret Leosdottir, M.D., Ph.D., from Skåne University Hospital in Malmö, Sweden, and colleagues examined the impact of delayed treatment escalation on outcomes by comparing early versus late oral combination LLT in LLT-naïve patients hospitalized for MI and discharged on statins. Differences in the risks for major adverse cardiovascular events (MACE; death, MI, stroke), MACE components, and cardiovascular death were compared between patients with ezetimibe added to statins ≤12 weeks after discharge (early combination therapy), from 13 weeks to 16 months (late combination therapy), or not at all.
The study included 35,826 patients. In all groups, high-intensity statin use was ≥98 percent. The researchers found that 2,570 patients had MACE during a median 3.96 years. One-year MACE incidences were 1.79, 2.58, and 4.03 per 100 patient-years for early, late, and no ezetimibe, respectively. For late versus early combination therapy, weighted risk differences in MACE were 0.6, 1.1, and 0.7 percent at one, two, and three years, respectively; the three-year hazard ratio was 1.14 (95 percent confidence interval, 0.95 to 1.41). Risk differences were 0.7, 1.6, and 1.9 percent at one, two, and three years for those receiving no ezetimibe; the three-year hazard ratio was 1.29 (95 percent confidence interval, 1.12 to 1.55).
"The need for combination therapy is inevitable for most patients after an MI," the authors write. "A delayed approach to LLT escalation is associated with avoidable harms."
Several authors disclosed ties to the biopharmaceutical industry.
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