Abstract 2982: Incidence of Myocardial Infarction or Stroke or All-Cause Mortality in Patients with Severe Carotid Arterial Disease Treated with and without Statins
Purpose: To investigate the incidence of myocardial infarction (MI) or stroke or all-cause mortality in patients with severe carotid arterial disease not revascularized treated with and without statins.
Methods: During a 5-year period, 449 patients (59% men), mean age 72 ± 10 years, with > 70% narrowing of 1 or 2 carotid arteries not revascularized were followed for the incidence of new MI or new stroke or all-cause mortality. Of the 449 patients, 298 (66%) were treated with statins. The mean age, gender, and prevalence of smoking, hypertension, diabetes mellitus, prior MI, and prior stroke were not significantly different between patients treated with and without statins. 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). 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: MI or stroke 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 development of new MI or new stroke or death were: use of statins (p < 0.0001; risk ratio = 0.13; 95% CI, 0.09 – 0.19); smoking (p = 0.0329; risk ratio = 1.45; 95% CI, 1.03–2.05); hypertension (p = 0.0011; risk ratio = 1.81; 95% CI, 1.27–2.58); diabetes mellitus (p < 0.0001; risk ratio = 2.87; 95% CI, 1.97– 4.19); prior MI (p < 0.0001; risk ratio = 2.15; 95% CI, 1.48–3.12); and prior stroke (p < 0.0001; risk ratio = 3.18; 95% CI, 2.24 – 4.52).
Conclusion: Statins significantly reduced the incidence of new MI or new stroke or death in patients with severe carotid arterial disease and hypercholesterolemia not treated with revascularization.