Strong Evidence To Support Patients With Carotid Disease With Statins - Especially Those Patients Undergoing Carotid Procedures

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

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There is a clear association between elevated serum cholesterol and stroke. Data from multiple prospective studies in both men and women has demonstrated an approximately twofold higher risk of ischemic stroke with increasing levels of total cholesterol.

Dr. Glenn LaMuraglia, Associate Professor of Surgery at the Harvard Medical School and Visiting Surgeon at Massachusetts General Hospital in Boston, Massachusetts, reviewed a meta-analysis of prospective trials that included approximately 90,000 patients treated with several different inhibitors of HMG-CoA reductase (statins) showed that the reduction in the risk of stroke was directly correlated to the degree of lowering of the LDL.

Dr. LaMuraglia pointed out, however, that cholesterol lowering by nonstatin medications has not been found to have similar effects in significant reductions of fatal strokes. It has been postulated that other effects of the statins, which include a reduction in the inflammatory process, are also responsible for the results by augmenting the benefits of cholesterol lowering.

The PHYLLIS and METEOR were prospective, randomized trials that evaluated the effect of a statin therapy on patients with asymptomatic carotid disease with regard to the progression of carotid atherosclerosis. There was a significant reduction of the progression of intima-media thickness (sign of atherosclerotic disease) related to statin therapy, suggesting the beneficial effects of statin therapy on the progression of atherosclerosis. Studies have also demonstrated plaque stabilization and regression in artery wall thickness in plaques of patients treated with intensive statin therapy. This has lead to an examination of stroke rates in patients treated preoperatively with statins who underwent CEA and CAS. In both instances, a periprocedural protection from stroke has been demonstrated.

This suggests that statin therapy can have a major acute effect on the inflammatory process of carotid atherosclerosis that may impact these clinical observations. Importantly, this would indicate that patients with carotid disease, and especially those undergoing carotid procedures, should be treated with statins.

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