High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management
Elin Good, Toste Länne, Elisabeth Wilhelm, Joep Perk, Tiny Jaarsma, Ebo de Muinck, Elin Good, Toste Länne, Elisabeth Wilhelm, Joep Perk, Tiny Jaarsma, Ebo de Muinck
Abstract
Background: Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown.
Design: Cross-sectional retrospective study.
Methods: Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA).
Results: A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke.
Conclusions: The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.
Keywords: High-grade carotid stenosis; atherosclerosis; cardiovascular disease; cardiovascular risk management; secondary prevention.
© The European Society of Cardiology 2016.
Source: PubMed