Are patients receiving maximal medical therapy following carotid endarterectomy?
BACKGROUND
Most patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) did not receive lipid-lowering treatment. As vascular event rates can be lowered with statins, antihypertensive agents, and newer antiplatelet agents, the authors conducted a study to determine the usage of these medications in patients following carotid endarterectomy (CE).


METHODS
Claims data from Blue Cross and Blue Shield Michigan were used to study non-Medicare members who underwent CE in the years 1999 to 2001 (n = 1,049). Prescription of pharmacotherapy and sustained use (>80% use of the follow-up period) were examined in the 365-day period following index CE.


RESULTS
Overall, 1,049 individuals underwent CE during the years 1999 to 2001. For the 1-year period following CE, the statin prescription rate was 70, 66, and 73% for the 3 study years. Sustained statin use was noted, on average, in 38%. The 3-year average was lower for sustained use of angiotensin-converting enzyme inhibitor (19%) and even lower for prescription antiplatelet agents (5%).


CONCLUSIONS
Use of statins has increased following carotid endarterectomy (CE) compared with the North American Symptomatic Carotid Endarterectomy Trial era, but sustained treatment with statins remains at <40%. Recent studies have shown a decrease in vascular event rates with statins regardless of low-density lipoprotein level, suggesting that statin use should be routine following CE. Increased statin use as part of a multimodality intensive medical regimen following CE has the potential to improve long-term vascular event rates in this population.
Betancourt
M
M
Blue Cross and Blue Shield of Michigan Center for Health Care Quality & Evaluative Studies, Detroit, USA.
Van Stavern
R B
RB
Share
D
D
Gardella
P
P
Martus
M
M
Chaturvedi
S
S
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D054598:Blue Cross Blue Shield Insurance Plans / Q000706:statistics & numerical data; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000601:surgery; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011182:Postoperative Care; D012189:Retrospective Studies; D012307:Risk Factors; D016312:Treatment Refusal
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL; D010975:Platelet Aggregation Inhibitors