Statins underused for the ‘other’ CAD: carotid artery disease
Continued use of statins was associated with a 25 percent reduced risk of major adverse cardiovascular events in patients following carotid revascularization, according to a Canadian study with five years of follow-up.
Notably, only 73.6 percent of the patients were on statins prior to revascularization, despite clinical guidelines recommending their use in people with established cardiovascular disease (CVD) or deemed to be at high risk of CVD. And only 68.9 percent were taking moderate to high doses at study enrollment, reported senior author Mohammed Al‐Omran, MD, MSc, a vascular surgeon at St. Michael’s Hospital in Toronto.
“Improving statin utilization among patients with significant carotid artery stenosis should be a key component of quality programs and may translate to better long‐term outcomes,” Al-Omran et al. wrote in the Journal of the American Heart Association.
The researchers analyzed data from more than 10,000 patients who were at least 66 years and underwent carotid endarterectomy or stenting in Ontario, Canada, from 2002 to 2014. Similar to the long-term findings, individuals who were taking statins prior to the procedure demonstrated a 24 percent reduced risk of meeting the composite endpoint (stroke, death or myocardial infarction) at one year.
The benefit of the therapy appeared especially powerful in the endarterectomy group, which demonstrated a 27 percent reduction in the primary endpoint with statins. The adjusted risk reduction was 14 percent for carotid artery stenting, according to a subgroup analysis.
“Events rates were lower after both carotid endarterectomy and stenting with statin use, and the protective association with statin use was observed regardless of carotid artery symptom status and statin intensity,” the authors wrote. “Given the significant morbidity and disability associated with stroke, our results may have important public health implications.”
Overall, the findings show statins are underused in patients with noncoronary atherosclerosis, Al-Omran and colleagues noted. Study participants with concomitant coronary artery disease were significantly more likely to be on statins prior to their carotid procedures (82 versus 71 percent).
On a positive note, individuals were increasingly prescribed statins during the follow-up period—78.1 percent of patients were taking the medications at one year and 81.9 percent of survivors at five years used the drugs.
“Future research in this area should focus on exploring the influence of different lipid levels on carotid plaques and clinical outcomes,” Al-Omran and coauthors suggested.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.