High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management
Elin Good1, Toste Länne2, Elisabeth Wilhelm2
1Department of Medicine and Health Sciences, Linköping University, Sweden elin.good@liu.se.
Insights
Patients with high-grade carotid artery stenosis face high cardiovascular event rates. Cardiovascular risk management was found to be deficient across all assessed aspects in this patient group.
Area of Science:
- Vascular Surgery
- Cardiology
- Public Health
Background:
- High-grade carotid artery stenosis (CAS) patients are at elevated risk for cardiovascular (CV) events.
- The effectiveness of CV risk management in this high-risk population remains largely uncharacterized.
Purpose of the Study:
- To evaluate the quality of cardiovascular risk management in patients diagnosed with high-grade CAS.
- To assess CV risk factors, co-morbidities, and outcomes in CAS patients undergoing either carotid endarterectomy (CEA) or conservative management (CM).
Main Methods:
- A retrospective, cross-sectional study analyzed data from 393 patients with high-grade CAS in Östergötland county, Sweden (2009-2012).
- Patient data included CV risk management quality, co-morbidities, and 2-year outcomes post-CAS diagnosis, irrespective of treatment (CEA or CM).
Main Results:
- While prescriptions for antiplatelet agents, statins, and antihypertensives increased post-diagnosis, target levels (e.g., LDL) were unmet in most patients.
- Lipid levels were not measured in a significant proportion of patients (19.8% CEA, 44.2% CM). HbA1c was also frequently unmeasured in diabetic patients.
- No documentation of lifestyle counseling (diet, exercise, smoking cessation) was found. The combined clinical event rate was high (36.8% CEA, 36.9% CM) with no significant difference between groups.
Conclusions:
- Patients with high-grade CAS experience a high rate of clinical events.
- Current cardiovascular risk management for high-grade CAS patients is inadequate across multiple domains, including medication adherence, target attainment, and lifestyle counseling.
Background:
Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown.
Design:
Cross-sectional retrospective study.
Methods:
Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA).
Results:
A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke.
Conclusions:
The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.
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