Managing hypercholesterolemia and its correlation with carotid plaque morphology in patients undergoing carotid
Kittipan Rerkasem1, Patrick J Gallagher, Robert F Grimble
1Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. krerkase@mail.med.cmu.ac.th
Insights
Management of high cholesterol in patients undergoing carotid endarterectomy (CEA) is inadequate. Many patients awaiting CEA have uncontrolled hypercholesterolemia, indicating a need for better lipid management strategies.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Lipidology
Background:
- Hypercholesterolemia is a significant risk factor in carotid atherosclerosis.
- Effective management of lipid risk factors is crucial for patients with carotid stenosis.
- Limited research exists on the attention given to lipid management in patients awaiting carotid endarterectomy (CEA).
Purpose of the Study:
- To evaluate the management of hypercholesterolemia in patients scheduled for CEA.
- To assess patient awareness of their hypercholesterolemia status.
- To examine the relationship between cholesterol levels and carotid plaque morphology.
Main Methods:
- Prospective study of 141 consecutive patients undergoing elective CEA.
- Collection of patient medical history and plasma cholesterol levels.
- Histological scoring of carotid plaques using established criteria.
Main Results:
- 28.6% of treated hypercholesterolemic patients awaiting CEA had cholesterol levels >= 5 mmol/L.
- 32.5% of patients informed they had no hypercholesterolemia had cholesterol levels >= 5 mmol/L.
- 48.4% of patients with unmeasured cholesterol had levels >= 5 mmol/L, with a tendency towards more severe plaque pathology.
Conclusions:
- Hypercholesterolemia appears to be poorly managed in the population of patients awaiting CEA.
- There is a significant gap in lipid management and patient awareness for this high-risk group.
- Improved strategies for cholesterol management are warranted for patients with carotid stenosis.
Purpose:
Hypercholesterolemia is a critical problem in patients with carotid atherosclerosis. The adequacy of attention to lipid risk factors in patients with carotid stenosis awaiting carotid endarterectomy (CEA) has rarely been studied. We also assessed patient awareness of hypercholesterolemia and carotid plaque morphology.
Methods:
A prospective study was conducted of 141 consecutive patients admitted electively for CEA. Each patient's medical history was taken. Plasma cholesterol concentrations were determined. Plaque histology was scored according to American Heart Association criteria and their modification.
Results:
Of patients who were aware of their hypercholesterolemia and who were receiving treatment, 28.6% had total cholesterol levels > or =5 mmol/L. Among those patients who had been told that they had no problem with hypercholesterolemia, 32.5% had plasma cholesterol concentrations > or =5 mmol/L. Among those patients who had never had their plasma cholesterol measured, 48.4% had total cholesterol levels > or =5 mmol/L. Patients in this last group tended to have more severe types of plaque pathology than those in other groups (12.9% plaque rupture).
Conclusions:
Hypercholesterolemia does not seem to be well managed in patients awaiting CEA.
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