Lipid goal achievement and trends in lipid-lowering therapy in veterans undergoing carotid endarterectomy.
Secondary prevention of cardiovascular disease after carotid endarterectomy should include management of low-density lipoprotein (LDL) levels, but increased LDL levels are undertreated in these patients. We examined trends in statin use and LDL goal achievement in veterans undergoing carotid endarterectomy (CEA), a medically high-risk group with high rates of cardiovascular morbidity and mortality. The records of all CEA performed between 1995 and 2005 in the Connecticut Veterans' Affairs (VA) hospital were reviewed. Kaplan-Meier analysis was used to analyze long-term outcomes. ANOVA was used for comparisons between groups. A total of 309 CEA procedures were performed in 298 patients. The mean follow-up was 4.1 years. Statin use increased over time (12% in 1995, 84% in 2005) and mean LDL levels decreased (105 mg/dl in 1997, 90 mg/dl in 2007). The number of patients achieving LDL goals of 100 mg/dl or 70 mg/dl increased. Mean HDL levels decreased (53 mg/dl in 1997 and 38 mg/dl in 2007). Patients with three or more comorbid medical conditions were more likely to achieve LDL goals. At 12 years, freedom from stroke was 91%, freedom from myocardial infarction was 46% and survival was 12%. In conclusion, over the last decade, among patients who have undergone CEA, statin use has increased and LDL levels have improved.
Fitzgerald
Tamara N
TN
Department of Surgery, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
Popp
Cathy
C
Dardik
Alan
A
Federman
Daniel G
DG
D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002340:Carotid Artery Diseases / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D003237:Connecticut / Q000453:epidemiology; D004363:Drug Utilization; D016894:Endarterectomy, Carotid; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008055:Lipids / Q000097:blood*; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids