SVS: Statin use prior to CAS can reduce rates of death, stroke

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Boston—For patients undergoing carotid artery stenting (CAS), use of statins can decrease perioperative and late stroke rates and also reduce mortality, said Paola De Rango, MD, of the University of Perugia in Perugia, Italy, during a presentation at the 2010 Society for Vascular Surgery (SVS) meeting June 10.

Between 2003 and 2009, De Rango and colleagues evaluated patients undergoing CAS for a carotid stenosis to assess the independent association of statin and morbidity.

“There is in increasing evidence to suggest the benefits of statin in patients with cardiovascular disease,” said De Rango.

The researchers looked at 1,083 patients—43 percent (n=464) were taking statin therapy prior to the procedure. Of the cohort, 29 percent of patients were female and patients had a mean age of 71.6 years.

According to De Rango, “Carotid angioplasty has been considered the hardest procedure due to its high procedural risk.”

Results showed that statin therapy reduced perioperative stroke, major stroke rate and mortality. However, De Rango said that these rates were even lower in symptomatic patients.

“The benefits are doubled,” said De Rango. “Long-term benefits of use of statin have been shown to decrease cardiovascular risk and stroke risk.”

Additionally, after 60 months of follow-up, the researchers found that stroke free rates where higher within the statin arm compared to those who were not previously administered statins, 78 percent versus 82 percent, respectively.

“Use of statin has also been found to be associated with a decreased rate of complications during vascular procedure,” explained De Rango.

However, De Rango said that patients are under treated and while she said that prior studies that review the correlation between statins and CAS are scarce, they have shown that only about 30 percent of patients are treated with the correct therapy.

During the study, the researchers also adjusted for demographics and comorbidities, finding that statin use was an independent variable for reducing long-term mortality rates and decreasing the risk of late stroke.

While there was no association between statin use and restenosis rates, De Rango said they found that “statin use was associated with a twofold reduction in procedural risk.”

As for the recommended duration of patients to be on statins prior to procedures, De Rango said that it would be recommended for patients to be administered and taking statin at least one month prior to the CAS procedure.

Lastly, the authors concluded that “statin therapy should be considered part of the best medical treatment in current CAS practice.”