PURPOSE: To investigate the incidence of stroke or myocardial infarction (MI) or death in patients with carotid arterial disease not revascularized treated with and without statins.
METHODS: Four hundred and forty-nine patients (59% men), mean age 72 years, with >70% narrowing of 1 or 2 carotid arteries not revascularized were followed for the incidence of new stroke or new MI or all-cause mortality. Of 449 patients, 298 (66%) were treated with statins. The mean age, gender, and prevalence of hypertension, diabetes mellitus, smoking, prior stroke, and prior MI were not significantly different between patients treated with and without statins. Hypercholesterolemia (a serum total cholesterol ≥ 200 mg/dl) was present in 298 of 298 patients (100%) treated with statins and in 145 of 151 patients (96%) not treated with statins (p = 0.001). Mean follow-up was 26 ± 18 months in patients treated with statins and 21 ± 17 months in patients not treated with statins (p<0.0001).
RESULTS: New stroke or new MI or death occurred in 45 of 298 patients (15%) treated with statins and in 102 of 151 patients (68%) not treated with statins (p<0.0001). Stepwise Cox regression analysis showed that significant independent predictors for the time to the development of new stroke or new MI or death were use of statins (p<0.0001; risk ratio = 0.13); smoking ( p = 0.0329; risk ratio = 1.45); hypertension (p = 0.0011; risk ratio = 1.81); diabetes mellitus (p <0.0001; risk ratio = 2.87); prior stroke (p < 0.0001; risk ratio = 3.18); and prior MI (p,0.0001; risk ratio = 2.15).
CONCLUSION: Statins significantly reduced the incidence of new stroke or new MI or death in patients with hypercholesterolemia and severe carotid arterial disease not treated with revascularization.
CLINICAL IMPLICATIONS: Patients with carotid arterial disease and hypercholesterolemia should be treated with statins to reduce the incidence of new stroke or new MI or death.
DISCLOSURE: Gautham Ravipati, None.