Effect of lipid-lowering therapy on carotid plaque burden in older adults

Stella Iankov; Aditya Sikand; Joy Chowdhury; J David Spence; Shahram Arsang Jang; Seyed Mojtaba Sohrevardi; Daniel G Hackam; M Reza Azarpazhooh

doi:10.1016/j.jns.2024.123023

Effect of lipid-lowering therapy on carotid plaque burden in older adults

J Neurol Sci. 2024 Apr 30:461:123023. doi: 10.1016/j.jns.2024.123023. Online ahead of print.

Authors

Stella Iankov¹, Aditya Sikand², Joy Chowdhury³, J David Spence⁴, Shahram Arsang Jang⁵, Seyed Mojtaba Sohrevardi⁶, Daniel G Hackam⁷, M Reza Azarpazhooh⁸

Affiliations

¹ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. Electronic address: siankov@uwo.ca.
² Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. Electronic address: asikand3@uwo.ca.
³ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
⁴ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada. Electronic address: dspence@robarts.ca.
⁵ Department of Biostatistics and Epidemiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.
⁶ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
⁷ Pharmaceutical Sciences Research Center, Faculty of Pharmacy, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.. Electronic address: dhackam@uwo.ca.
⁸ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Neuroscience, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada. Electronic address: reza.azarpazhooh@lhsc.on.ca.

PMID: 38718551
DOI: 10.1016/j.jns.2024.123023

Abstract

Background: Little is known about the benefits of lipid-lowering medications in those age ≥ 75 years. We assessed the effect of lipid-lowering medications on progression to severe atherosclerosis in patients age > 75.

Methods: Data was retrospectively obtained from the Stroke Prevention & Atherosclerosis Research Centre, Canada. Atherosclerosis burden was measured as carotid total plaque area (TPA), a powerful predictor of cardiovascular risk. Survival time free of severe atherosclerosis (SFSA) was defined as the period when TPA remained <1.19 cm². Kaplan-Meier, multiple Cox proportional hazard and hierarchical mixed-effect models were used to determine the effects of lipid-lowering medications on progression to severe atherosclerosis.

Results: In total 1404 cases (mean age 81 ± 4 years; women 52%) were included. Those taking lipid-lowering medications were more likely to have a history of diabetes and a higher burden of atherosclerosis at baseline. In Kaplan-Meier analysis, the SFSA was significantly longer in those receiving lipid-lowering therapy. In multivariable-adjusted analyses, those not receiving lipid lowering therapy (irrespective of their vascular disease at baseline) were more likely to have TPA > 1.19 cm² (hazard ratio (HR) = 1.37, 95% confidence interval (CI): 1.09,0.71). Similar findings were observed in mixed effects models when plaque progression was defined as any change >0.05 cm² per year (odds ratio (OR):2.17, 95% CI:1.38,3.57).

Conclusion: Lipid-lowering therapy is effective in controlling the burden of atherosclerosis among older adults with and without vascular disease. The measurement of plaque burden can guide selection and follow-up of those who may benefit from treatment.

Keywords: Atherosclerosis; Carotid plaque; Lipid-lowering medications; Older adults; Ultrasound.