Study Examines Effects of Statins on Early and Late Results of CAS

January 4, 2011—In the Journal of Vascular Surgery, Fabio Verzini, MD, et al published findings from a study that aimed to investigate whether statin use was associated with decreased perioperative and late risks of stroke, mortality, and restenosis in patients undergoing carotid angioplasty and stenting (CAS) for carotid stenosis (2011;53:71–79). The investigators noted that increasing data suggest that statins can significantly decrease cardiovascular and cerebrovascular events due to a plaque stabilization effect. However, the benefit of statins in patients undergoing CAS is not well defined.

As detailed by the investigators, patients undergoing CAS for primary carotid stenosis from 2004 to 2009 were reviewed. The independent association of statins and perioperative morbidity was assessed using multivariable analysis. Survival curves and Cox regression models were used to assess late morbidity and restenosis. Propensity score adjustment was employed.

The investigators reported that 1,083 consecutive CAS procedures were performed (29% women; mean age, 71.5 years; 24.7% symptomatic); 465 (43%) were on statin medication before treatment, which was not discontinued at discharge. Statin use was associated with a reduction of perioperative stroke and death (odds ratio [OR], 0.327; 95% confidence interval [CI], 0.13–0.8; P = .016) according to multivariable analysis. Statin effect was more significant in reducing stroke and death in symptomatic patients (OR, 0.13; P = .032) and in men (OR, 0.27; P = .01).

At 5 years, survival rates (87.2% vs 78.3%; P = .009) and ischemic stroke-free interval rates (88.9% vs 99.7%; P = .02) were higher in the statin group of patients. Adjusting for propensity score and covariates in Cox regression analyses, statin use was independently associated with reduced long-term mortality risk (hazard ratio [HR], 0.56; 95% CI, 0.32–0.97; P = .039) and borderline associated with decreased late ischemic stroke risk (HR, 0.14; 95% CI, 0.018–1.08; P = .059). There was no impact on restenosis rates, the investigators found.

The investigators concluded that these data suggest that statin use is associated with decreased perioperative and late ischemic stroke risk and reduced mortality rates in patients undergoing CAS and that statin therapy should be considered part of the best medical treatment in current CAS practice.