Impact of carotid endarterectomy on medical secondary prevention after a stroke or a transient ischemic attack: results from the Reduction of Atherothrombosis for Continued Health (REACH) registry.
OBJECTIVE
Whether a history of carotid endarterectomy influences patient compliance with medical treatments and physician attitude toward treatments after ischemic stroke or transient ischemic attack (TIA) is not well known.


METHODS
We studied the baseline data of 18,467 ischemic stroke and TIA patients from the international REduction of Atherothrombosis for Continued Health (REACH) Registry and investigated the impact of a history of endarterectomy on the secondary medical prevention measured by the use of antiplatelet agents and statins, and by the control of cholesterol level, glucose level, and blood pressure.


RESULTS
Among the patients with a history of ischemic stroke or TIA, those with a history of endarterectomy (n=1474) were more likely to receive antiplatelet agents and statins, to have a blood pressure <140/90 mm Hg, and a fasting total cholesterol <200 mg/dL. In diabetic patients, endarterectomy was associated with lower fasting blood glucose levels. In multivariate logistic regression analyses, endarterectomy was significantly associated with the use of antiplatelet agents (odds ratio [OR], 1.6; 95% CI, 1.3 to 1.9; P<0.0001) and statins (OR, 1.8; 1.6 to 2.0; P<0.0001), and with a cholesterol level <200 mg/dL (OR, 1.3; 1.2 to 1.5; P<0.0001). By contrast, the associations with blood pressure and blood glucose levels were no longer significant. There was no heterogeneity across the world regions or among the specialists who enrolled the patients.


CONCLUSIONS
Carotid endarterectomy is associated with a higher use of antiplatelet agents and statins in stroke/TIA patients. The absence of such an association with blood pressure and blood glucose control suggests that the individual determinants of the quality of the secondary medical prevention vary from one risk factor to another and from one class of drugs to another.
Touzé
Emmanuel
E
Faculté de Médecine René Descartes, Université Paris 5, EA 4055, Department of Neurology, Paris, France.
Mas
Jean-Louis
JL
Röther
Joachim
J
Goto
Shinya
S
Hirsch
Alan T
AT
Ikeda
Yasuo
Y
Liau
Chiau-Suong
CS
Ohman
E Magnus
EM
Richard
Alain J
AJ
Wilson
Peter W F
PW
Steg
P Gabriel
PG
Bhatt
Deepak L
DL
D000368:Aged; D000369:Aged, 80 and over; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology* / Q000601:surgery; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery
D010975:Platelet Aggregation Inhibitors