Upfront Combination Therapy vs Statin Monotherapy in ACS Patients
Introduction
Heart diseases remain a leading cause of mortality worldwide. Acute coronary syndrome (ACS) refers to a group of conditions: ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), and unstable angina. ACS is responsible for a third of deaths in people over 35 years old. ACS can be managed by lipid-lowering therapy (LLT) to lower the risk factors contributing to illness.
The Need for LLT
Preventing dyslipidaemia, an imbalance of lipids (like cholesterol) in the blood, is key for improving outcomes for ACS patients. Statins are drugs that can lower your cholesterol. It’s important to start treatment early and keep lipid levels lower long term. In many cases, this can be challenging, with less than a third of patients reaching their target levels. This is where combination therapy can help!
Traditionally, the recommended approach involves starting with monotherapy of a statin drug the adding other LLT if needed, typically after 4-6 weeks. In such cases, the preferred strategy is combining a statin with ezetimibe. If the target lipid level is still not reached, the introduction of PCSK9 inhibitors is recommended.
Upfront Combination Therapy
Recognising the challenges in reaching treatment goals and the need to better reduce the risk of heart disease, experts have suggested immediate/upfront combination therapy of statin and ezetimibe. This involves both drugs being started at the same time. This allows the use of PCSK9 inhibitors after only 4 to 6 weeks, if needed.
Study Objectives
The aim of this study was to assess whether statin monotherapy or upfront combination LLT is better in treating ACS patients, using data from the Polish Registry of Acute Coronary Syndromes.
Results
The study found that the group on upfront combination therapy had lower death rates than those on statin monotherapy. This suggests that immediate combination lipid-lowering therapy may be beneficial for ACS patients, particularly those at high risk.
Find the original paper here!
Intensive Statin Therapy Versus Upfront Combination Therapy of Statin and Ezetimibe in Patients With Acute Coronary Syndrome: A Propensity Score Matching Analysis Based on the PL‐ACS Data.
