2 drug combination lowers cholesterol better than just a statin, researchers say

Statins are very cheap and highly effective cholesterol-lowering drugs -- but high-risk heart patients may have an even better option, a new evidence review says.
Combining statins with another drug, ezetimibe, significantly reduces the risk of death in patients with clogged arteries, according to findings published Sunday in Mayo Clinic Proceedings.
Using a high-dose statin with ezetimibe significantly reduces levels of "bad" LDL cholesterol, increasing a person's chances of reaching healthy levels by 85%, researchers found.
The combo also brought about a 19% reduction in risk of death from any cause; a 16% reduction in heart-related deaths; an 18% decrease in the risk of a major cardiovascular health problem; and a 17% decline in stroke risk.
This combination therapy would prevent more than 330,000 deaths a year worldwide among patients who have already suffered a heart attack, including almost 50,000 deaths in the U.S. alone, researchers said.
"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 after an acute cardiovascular event," senior researcher Dr. Peter Toth, a professor of clinical family and community medicine at the University of Illinois, said in a news release.
Up to now, studies have been inconsistent regarding whether to provide combo cholesterol-lowering therapy immediately for high-risk patients, even before they suffer a heart attack or stroke.
Typically, doctors wait at least two months before adding any medication to a statin, to see how well statins alone will lower cholesterol, Toth said.
"This approach does not require additional funding or reimbursement of new expensive drugs," he said. "In fact, it may translate into lower rates of first and subsequent heart attacks and stroke, and their complications like heart failure, which are extremely costly for all healthcare systems."
For the new evidence review, researchers pooled data from 14 studies involving more than 108,000 heart patients at very high risk for a heart attack, stroke or other heart-related health problem.
Results were even more pronounced in an additional analysis that enabled a direct comparison of different therapies, researchers said.
"This showed a 49% reduction in all-cause mortality and a 39% reduction in major adverse cardiovascular events, when compared to high dose statin therapy alone," said lead researcher Dr. Maciej Banach, a professor of cardiology at the John Paul II Catholic University of Lublin in Poland.
Ezetimibe works by reducing the amount of cholesterol the intestines can absorb from food. Statins have a different mechanism - they work by interfering with the liver's ability to make cholesterol. Both drugs are available as inexpensive generics.
"Our findings underline the importance of the adages 'the lower for better for longer' but also the equally important 'the earlier the better' for treating patients at high risk of cardiovascular conditions and to avoid further medical complications and deaths," Toth said.
More information
The Cleveland Clinic has more on cholesterol levels.
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