J AM Coll Cardiol

Early ezetimibe initiation may significantly improve post-MI outcomes

April 30, 2025

Study details: This study analyzed data from the SWEDEHEART registry, including 35,826 lipid-lowering therapy-naïve patients hospitalized for MI between 2015 and 2022. Patients were categorized based on the timing of ezetimibe initiation: within 12 weeks (early), between 13 weeks and 16 months (late), or no ezetimibe. Primary outcome was the incidence of major adverse cardiovascular events (MACE), including death, MI, and stroke, over a median follow-up of 3.96 years.

Results: Early initiation of ezetimibe was associated with a significantly reduced incidence of MACE compared with late initiation and no ezetimibe. One-year MACE incidences were 1.79, 2.58, and 4.03 per 100 patient-years for early, late, and no ezetimibe groups, respectively. The three-year hazard ratios (HRs) for MACE were 1.14 (late vs. early) and 1.29 (none vs. early). CV death risk was also lower in the early group, with HRs of 1.64 (late) and 1.83 (none).

Clinical impact: The findings suggest that early initiation of ezetimibe, in combination with statins, can substantially improve long-term CV outcomes for post-MI patients. This approach may warrant consideration for inclusion in updated clinical guidelines to enhance secondary prevention strategies.

Source:

Leosdottir M, et al. (2025, April 22). J Am Coll Cardiol. Early Ezetimibe Initiation After Myocardial Infarction Protects Against Later Cardiovascular Outcomes in the SWEDEHEART Registry. https://pubmed.ncbi.nlm.nih.gov/40240093/