Related Experiment Video
Updated: Jul 13, 2025
A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Patients with Prior Exposure to a Combination of Statins & Angiotensin-Converting Enzyme Inhibitors
Daniel Willie-Permor1, Shima Rahgozar1, Sina Zarrintan1
1Department of Surgery, Center for Learning and Excellence in Vascular & Endovascular Research(CLEVER), University of California San Diego (UCSD), La Jolla, CA.
Insights
Combining statins with Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARBs) perioperatively significantly reduces mortality and stroke risk in patients undergoing carotid revascularization. This combination therapy offers superior protection compared to statins alone for these vascular procedures.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Pharmacology
Background:
- Statin therapy is established to improve outcomes following carotid endarterectomy (CEA) and carotid artery stenting (CAS).
- The role of continuing or withholding Angiotensin-converting enzyme inhibitors (ACE-Is) or Angiotensin Receptor Blockers (ARBs) during CEA/CAS is less understood.
- This study investigates the combined effect of perioperative statins and ACE-Is/ARBs on patient outcomes.
Purpose of the Study:
- To evaluate the impact of preoperative statin use combined with ACE-Is/ARBs on mortality and morbidity in patients undergoing CEA or CAS.
- To compare outcomes between patients receiving statins alone versus those receiving both statins and ACE-Is/ARBs.
Main Methods:
- Analysis of data from the Vascular Quality Initiative (2016-2021) for patients undergoing carotid revascularization (CEA, Transcarotid Artery Revascularization, Transfemoral Carotid Artery Stenting).
- Primary outcome: 30-day mortality/stroke.
- Secondary outcomes: Postoperative myocardial infarction and congestive heart failure. Poisson regression was used for analysis.
Main Results:
- A total of 131,285 patients were analyzed; 54% received both statins and ACE-Is/ARBs preoperatively.
- The combination of statins and ACE-Is/ARBs was associated with a 12% lower risk of 30-day mortality/stroke (IRR 0.88, P=0.001).
- This group also showed an 18% lower risk of postoperative congestive heart failure (IRR 0.82, P=0.029) but a similar risk of myocardial infarction.
Conclusions:
- Perioperative use of statins combined with ACE-Is/ARBs provides enhanced protection compared to statins alone in patients undergoing carotid revascularization.
- Continuation of ACE-Is/ARBs is recommended for patients undergoing carotid revascularization, particularly those with hypertension.
- Further prospective research is warranted to confirm the benefits of adding ACE-Is/ARBs to statin therapy in this patient population.
Background:
Statin use has been studied and confirmed to have a beneficial impact on perioperative carotid endarterectomy (CEA) and carotid artery stenting (CAS) outcomes. The benefits of Angiotensin-converting enzyme inhibitors (ACE-I) in hypertension, ischemic heart disease, heart failure, diabetes mellitus, and renal disease are well-known; however, the impact of continuing or withholding ACE-Is/angiotensin receptor blockers (ARBs) on CEA and CAS outcomes is not addressed well in the literature. This study aimed to evaluate the impact of preoperative statin use combined with ACE-Is/ARBs in patients undergoing CEA or CAS on mortality and morbidity using a multi-institutional database.
Methods:
Using the data of all patients who underwent carotid artery revascularization, including CEA, transcarotid artery revascularization, and transfemoral carotid artery stenting from 2016 to 2021 in the Vascular Quality Initiative data, we determined as our primary outcome 30-day mortality/stroke after carotid revascularization based on periop exposure to statins alone, or the combination of statins and ACE-Is/ARBs. Secondary outcomes were postop myocardial infarction and postop congestive heart failure. Poisson regression with robust variance was used to determine postop outcomes comparing the combination of statin and ACE-Is/ARBs group with statins alone group.
Results:
A total of 131,285 patients were included in the study, with 59,860 (46%) patients receiving statin only, and 71,425 (54%) receiving both statin and ACE-Is/ARBs preoperatively. Both patient groups differed significantly in preop clinical and demographic characteristics. After adjusting for potential confounders, the statins plus ACE-I/ARB group had a 12% lower risk of postop mortality/stroke (Incident Rate Ratio comparing Statin/ACE group to Statins Only group [IRR] 0.88, 95% confidence interval 0.81-0.95, P = 0.001), 18% lower risk of postop congestive heart failure (IRR 0.82, 95% CI 0.68-0.98, P = 0.029), and similar risk of postop myocardial infarction (IRR 1.05 95% confidence interval 0.91-1.20, P = 0.54) compared to the statin-only group.
Conclusion:
Statins combined with ACE-Is/ARBs perioperatively offer better protection compared to statins alone in patients undergoing carotid revascularization surgery. We recommend the continuation of ACE-Is/ARBs use in patients undergoing carotid revascularization, especially if they have concurrent hypertension. Further prospective studies are needed to evaluate the benefit of adding ACE-Is/ARBs.
Related Concept Videos
01:26Atherosclerosis III: Management
01:27Coronary Artery Disease V: Interprofessional Care
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:23Atherosclerosis IV: Nursing Management
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...