Key Elements Of Best Medical Treatment In Carotid Stenosis Patients Revealed - Encouraging Correlation Of Lowering LDL With Decreased Stroke Risk

Main Category: Cardiovascular / Cardiology
Also Included In: Cholesterol
Article Date: 24 Nov 2008 - 1:00 PDT

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Carotid artery disease is one of many atherosclerotic manifestations and it is associated with increased risk of stroke, myocardial infarction and death.

Carotid surgery has been shown to reduce the risk of stroke both in symptomatic and asymptomatic patients although the benefit is by far larger in symptomatic patients with recent symptoms. But, as Dr. Henrik Sillesen, Chairman, Department of Vascular Surgery of the University of Copenhagen (Denmark) asked in his, what is the role of medical therapy that lowers LDL in the treatment of carotid artery disease?

Many of the trials that showed the effectiveness of carotid artery endarterectomy in preventing strokes did not include an optimal medical treatment arm. And, in fact, over the past few years, the ability of statins (LDL lowering) to limit atherosclerotic disease progression has gained attention.

Dr. Sillesen addressed the question regarding how low should the LDL be by pointing out that in the SPARCL trial patients who reached a LDL cholesterol below 70 mg/dl had the greatest benefit without more clinical side effects. Also, recent data from the Oxford Express clinic showed that providing medical therapy immediately (statins and platelet inhibitors within 24 hours) to patients with acute cerebrovascular symptoms had a dramatic effect as compared to providing treatment when later referral was done.

Dr. Sillesen concluded that surgical benefit from "ancient" randomized trials is not valid any more. He stated, "We need new trials testing current medical therapy combined with the life style today to current intervention. Some would argue that it is unethical to redo the classic surgical trials - I would argue the opposite."

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Source
Pauline T. Mayer
http://www.ptmhcm.com