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Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization
Mohamad A Hussain1,2, Gustavo Saposnik3,4,5,6,7, Sneha Raju2
11 Division of Vascular Surgery St. Michael's Hospital Toronto Ontario Canada.
Insights
Statin therapy significantly reduces major adverse cardiac and cerebrovascular events in patients undergoing carotid revascularization. Continuous statin use is associated with a 25% lower risk of long-term cardiovascular events in this population.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Statins are widely used for cardiovascular event prevention but underutilized in noncoronary atherosclerosis.
- Carotid artery disease management often overlooks the benefits of statin therapy.
- Understanding statin use and impact in carotid revascularization is crucial.
Purpose of the Study:
- To determine statin utilization rates in patients undergoing carotid revascularization.
- To investigate the association between statin therapy and outcomes post-carotid revascularization.
- To evaluate the long-term effects of continuous statin use.
Main Methods:
- Population-level retrospective cohort study in Ontario, Canada (2002-2014).
- Included patients aged ≥66 years undergoing carotid endarterectomy or stenting.
- Used propensity score weighting to adjust for confounding factors and analyzed 1-year and 5-year outcomes.
Main Results:
- 73.6% of patients received preprocedural statin therapy; 68.9% received moderate- or high-dose therapy.
- Statin users had a lower 1-year composite rate of stroke, myocardial infarction, or death (aHR: 0.76).
- Persistent long-term statin therapy was linked to a 25% lower 5-year risk of major adverse cardiac and cerebrovascular events (aHR: 0.75).
Conclusions:
- Continuous statin therapy is associated with significantly reduced long-term cardiovascular event risk in patients with carotid artery disease.
- Statins should be strongly considered for patients undergoing carotid revascularization.
- Increased statin utilization is recommended for this undertreated population.
Abstract:
Background Statins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization. Methods and Results In this population-level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002-2014). The primary outcome was a composite of 1-year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five-year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate- or high-dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1-year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70-0.83). Patients who were on persistent long-term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71-0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose. Conclusions Continuous statin therapy was associated with a 25% lower risk of long-term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.
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