Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy

A Giannopoulos; S Kakkos; A Abbott; A R Naylor; T Richards; D P Mikhailidis; G Geroulakos; A N Nicolaides

doi:10.1016/j.ejvs.2015.06.115

Long-term Mortality in Patients with Asymptomatic Carotid Stenosis: Implications for Statin Therapy

Eur J Vasc Endovasc Surg. 2015 Nov;50(5):573-82. doi: 10.1016/j.ejvs.2015.06.115. Epub 2015 Aug 20.

Authors

A Giannopoulos¹, S Kakkos², A Abbott³, A R Naylor⁴, T Richards⁵, D P Mikhailidis⁶, G Geroulakos⁷, A N Nicolaides⁸

Affiliations

¹ Department of Vascular Surgery, Imperial College, London, UK; Department of Vascular Surgery, University College London, London, UK. Electronic address: a.giannopoulos13@imperial.ac.uk.
² Department of Vascular Surgery, Imperial College, London, UK; Department of Vascular Surgery, University of Patras, Patras, Greece.
³ The School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
⁴ Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK.
⁵ Department of Vascular Surgery, University College London, London, UK.
⁶ Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London, London, UK.
⁷ Department of Vascular Surgery, Imperial College, London, UK; Department of Vascular Surgery, Ealing Hospital, London, UK.
⁸ Department of Vascular Surgery, Imperial College, London, UK; Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus.

PMID: 26299982
DOI: 10.1016/j.ejvs.2015.06.115

Abstract

Objective: Recent studies with asymptomatic carotid patients on best medical management have shown that the annual risk of stroke has decreased to approximately 1%. There is no evidence that a similar decrease in mortality has occurred. In addition, the intensity of statin therapy for these patients has not yet been determined. The aims of this review were to determine (a) the reported long-term all-cause and cardiac-related mortality in patients with asymptomatic carotid stenosis (ACS) > 50%, (b) whether there has been a decrease in mortality in recent years, (c) the available methods of mortality risk stratification, and (d) whether the latest ACC/AHA guidelines on the treatment of serum lipids can be applied to this group of patients.

Methods: Systematic review of PubMed, EuroPubMed, and Cochrane Library and meta-analysis using random effects for pooled proportions were performed regarding long-term all-cause and cardiac-related mortality and the associated risk factors in ACS patients. The last day for literature search was October 30, 2014.

Results: Seventeen studies were retrieved reporting 5-year all-cause mortality in 11,391 patients with ACS >50%. The 5-year cumulative all-cause mortality across all 17 studies was 23.6% (95% CI 20.50-26.80). Twelve additional studies, reporting both all-cause and cardiac mortality with a minimum of 2 year follow-up and involving 4,072 patients were identified. Of the 930 deaths reported, 589 (62.9%; 95% CI 58.81-66.89) were cardiac-related. This translates into an average cardiac-related mortality of 2.9% per year.

Conclusions: All-cause and cardiac mortality in ACS patients are very high. Although risk stratification is possible, most patients are classified as high risk. In view of this high risk, aggressive statin therapy is indicated if the new ACC/AHA guidelines on serum lipids are to be adhered to.

Keywords: All-cause mortality; Asymptomatic carotid stenosis; Cardiac-related mortality; Statin therapy.

Publication types

Review
Systematic Review

MeSH terms

Asymptomatic Diseases*
Carotid Stenosis / drug therapy*
Carotid Stenosis / mortality*
Cause of Death
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Risk Assessment
Time Factors

Substances

Hydroxymethylglutaryl-CoA Reductase Inhibitors