Related Experiment Video
Updated: Jun 25, 2025
Vascular Gene Transfer from Metallic Stent Surfaces Using Adenoviral Vectors Tethered through Hydrolysable Cross-linkers
Published on: August 12, 2014
Long-Term Drug Therapy Following Carotid Endarterectomy Aimed at Reducing Major Adverse Cardiovascular Events
Daryll Baker1, Xiaoyu Chen2, Lily Rahm3
1Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, UK; Vascular Surgery Service, The National Hospital for Neurology and Neurosurgery, University College Hospitals NHS Foundation Trust, London, UK; UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
Insights
Many years after carotid endarterectomy (CEA), patients maintained high rates of major adverse cardiovascular event (MACE)-reducing drug prescriptions. This suggests good adherence to lifelong medication for stroke prevention.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Pharmacology
Background:
- Carotid endarterectomy (CEA) is crucial for reducing stroke risk.
- Lifelong medication is vital for minimizing major adverse cardiovascular events (MACEs) post-CEA.
- Previous studies indicate significant discontinuation of these medications within 12 months.
Purpose of the Study:
- To evaluate the long-term prescription rates of MACE-reducing drugs following CEA.
- To compare current drug prescriptions with those at the time of CEA.
- To assess medication adherence in patients many years after carotid surgery.
Main Methods:
- Electronic health records of 347 post-CEA patients were analyzed.
- Prescriptions for antithrombotic, lipid-lowering, antihypertension, and diabetes drugs were compared.
- Medication data from 187 surviving patients were compared with their CEA prescriptions and with records of 160 deceased patients.
Main Results:
- Long-term prescription rates for MACE-reducing drugs remained high.
- Significant increases in antihypertension drug prescriptions were observed.
- No difference in drug prescription rates was found between survivors and non-survivors.
Conclusions:
- A higher-than-expected rate of MACE-reducing drug prescriptions persists many years post-CEA.
- This sustained adherence may be influenced by national healthcare systems.
- Findings support the importance of continued pharmacotherapy for secondary stroke prevention.
Background:
Timely carotid endarterectomy (CEA) reduces the risk of future stroke. This benefit is maximized with lifelong drug therapy aimed at reducing further major adverse cardiovascular events (MACEs), including stroke. Studies suggest that around half discontinue these drugs within 12 months. To assess if this is the case following CEA, we considered the MACE-reducing drugs prescribed several years later and compared this with the drugs they were prescribed at CEA.
Methods:
The electronic primary care records of 347 post-CEA patients a mean of 108 (range 43-185) months after surgery were interrogated. The prescriptions of generic MACE-reducing drugs (antithrombotic, lipid-lowering, antihypertension and diabetes) of the 187 alive were compared with their prescriptions at CEA and with the last prescription of the 160 who had died before the late review. The post-CEA incidence of further MACE in survivors was determined.
Results:
At late review, fewer of the post-CEA patients alive were taking antiplatelet drugs (143, 76% vs. 170, 91% P < 0.01), but more were fully anticoagulated (37v4 P < 0.01) when compared with prescriptions at CEA. Overall, there was no change in antithrombotic drug prescription rates (167, 89% vs. 172, 92%). Lipid-regulating drugs were well prescribed both at late review and at CEA (173, 93% vs. 169, 90%). The number prescribed antihypertension drugs was significantly higher at late review than at CEA (166, 89% vs. 67, 35% P < 0.01). The number treated for diabetes was similar (64, 34% vs. 42, 23%). There was no difference in the numbers of any of the MACE-reducing drugs prescribed between those who had survived to late review and those who had not. At late review, of those alive, there were 22 (12%) new strokes, and 24 (14%) had developed new or worsening ischemic cardiac symptoms.
Conclusions:
We found a higher than expected prescription rate of MACE-reducing drugs many years after CEA. This finding may be due, in part, to the nationalized health service in the United Kingdom.
Related Concept Videos
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:20Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...
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...