Thousands of lives could be saved by changing the rules around prescribing statins, according to research. The largest analysis to examine the best way to lower levels of "bad" cholesterol in patients with blocked arteries shows that they should immediately be given a combination of a statin and another drug, called ezetimibe, rather than statins alone.

The combination therapy should be considered the "gold standard" of treatment for patients who have already had a heart attack and could prevent thousands of deaths every year, say scientists. Researchers analysed the findings of 14 previous studies involving 108,353 patients who were at "very high" risk of a heart attack or stroke, or who had already suffered one of the other.

The study, published in the journal Mayo Clinic Proceedings, showsed that when ezetimibe was combined with a high dose statin to reduce levels of low density lipoprotein cholesterol (LDL-C), there was a "significant" 19% reduction in the risk of death from any cause.

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There was also a 16% reduction in deaths from cardiovascular causes, and a "significant" reduction in the major adverse cardiovascular events or stroke by 18% and 17% respectively, compared to high doses of statins alone. The combination therapy also significantly reduced LDL-C levels by an extra 13mg per decilitre (dL) of blood compared to statins alone, measured from the baseline – the time at which the patient first started the treatment.

That increased the chances of reaching the ideal goal of less than 70mg/dL of LDL-C by 85%, according to the findings. Study first author Professor Maciej Banach, of the John Paul II Catholic University of Lublin, Poland, said: “These results were even more pronounced in the network meta-analysis, which enables a direct comparison of different therapy regimens used in the study.

"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.” Prof Banach, who also leads the International Lipid Expert Panel and the Blood Pressure Meta-analysis Collaboration group that conducted the study, said: “The combination therapy is safe and efficacious.

"The risk of adverse events and the therapy discontinuation rate was comparable between groups. "In the network meta-analysis, we showed a significant 44% reduction in the risk of discontinuation in those treated with moderately high dose statin therapy plus ezetimibe versus a high dose statin alone.”

Until now, there had been inconsistent findings about whether or not combined cholesterol lowering therapy should be given to high risk patients immediately, even before they suffer a heart attack or stroke. Study co-author Professor Peter Toth, of the University of Illinois in the US, 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.

"Simply adding ezetimibe to statin therapy, without waiting for at least two months to see the effects of statin monotherapy, which is suboptimal in many patients, is associated with more effective LDL-C goal achievement and is responsible for significant incremental reductions in cardiovascular health problems and deaths.

“This approach does not require additional funding or reimbursement of new expensive drugs. "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.”

Figures show that around 4.5million deaths a year are a result of high LDL-C. Prof. Banach said: “Cardiovascular disease kills around 20 million people a year worldwide.

"Based on our previous analysis, we estimate that if combination therapy to reduce LDL-C was included in all treatment guidelines and implemented by doctors everywhere for patients with high cholesterol levels, it would prevent over 330,000 deaths a year among patients who have already suffered a heart attack, and almost 50,000 deaths alone in the USA. We recommend combination therapy should be considered the gold standard of treatment for these patients and included in all future treatment guidelines.”

Statins have been used safely for years. They help to lower LDL-C "bad" cholesterol by reducing the production of it by the liver. Ezetimibe reduces the amount of cholesterol that the body takes from food by inhibiting the absorption of it in the intestines.

Some patients do not respond adequately to statins and are prescribed ezetimibe in combination with a statin. High doses of statins are known as "high intensity" statins and moderately high doses are known as "moderate intensity" or "medium intensity" statins.

Prof. Toth added: “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.”