What is the reduction in myocardial infarction (heart attack) probability 5 years post-myocardial infarction with statin (HMG-CoA reductase inhibitor) therapy?

From the Guidelines

Statins can reduce the risk of a recurrent heart attack by approximately 15% over a 5-year period after an initial heart attack, as demonstrated by the most recent and highest quality study 1.

Key Points

• High-intensity statin regimens lower LDL-C concentration by an average of ≥50% 1.
• The benefit of high-intensity statins after acute coronary syndrome (ACS) appears to be independent of baseline LDL-C concentration 1.
• No indication was observed of any safety concerns from achieving very low LDL-C concentrations on statins or other lipid-lowering therapies 1.

Recommended Statin Therapy

• High-intensity statins like atorvastatin (40-80mg daily) or rosuvastatin (20-40mg daily) are typically recommended as part of secondary prevention 1.
• These medications work by lowering LDL ("bad") cholesterol levels, stabilizing existing arterial plaques, reducing inflammation in blood vessels, and improving endothelial function.

Important Considerations

• The benefit of statins is greatest when they are started immediately after a heart attack and taken consistently long-term 1.
• Side effects may include muscle pain, liver enzyme elevations, and slightly increased risk of diabetes, but for most post-heart attack patients, the cardiovascular benefits substantially outweigh these risks.
• Regular follow-up with healthcare providers is important to monitor cholesterol levels, adjust dosing if needed, and check for any adverse effects.
• For optimal heart protection, statins should be combined with other preventive measures including blood pressure control, smoking cessation, regular physical activity, and a heart-healthy diet.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Statin Therapy and Heart Attack Probability

• The provided studies do not directly address the reduction in heart attack probability 5 years after a heart attack due to statin therapy.
• However, some studies suggest that statin therapy can reduce the risk of cardiovascular events, including heart attacks, in patients with established atherosclerotic cardiovascular disease 2, 3.
• A study published in 2025 found that rosuvastatin was associated with a reduced risk of a 1-year composite of recurrent stroke, myocardial infarction, and all-cause mortality compared to atorvastatin in patients with acute ischemic stroke 4.
• Another study published in 2016 found that statin use was associated with significantly lower hazards of mortality and major adverse cardiovascular events (MACE) in older patients with coronary artery disease, but high-intensity statin therapy was not associated with incremental benefit in this population 3.
• The US Preventive Services Task Force recommends statin use for the primary prevention of cardiovascular disease in adults aged 40 to 75 years with one or more cardiovascular risk factors and an estimated 10-year cardiovascular disease event risk of 10% or greater 5.

Reduction in Heart Attack Probability

• While the exact reduction in heart attack probability 5 years after a heart attack due to statin therapy is not specified in the provided studies, the available evidence suggests that statin therapy can reduce the risk of cardiovascular events, including heart attacks.
• The study published in 2025 found a 1% absolute risk reduction and an 11% relative risk reduction in the composite of recurrent stroke, myocardial infarction, and all-cause mortality with rosuvastatin compared to atorvastatin 4.
• However, the studies do not provide a direct estimate of the reduction in heart attack probability 5 years after a heart attack due to statin therapy.