title: Best medical therapy or wishful thinking in carotid disease? A single-centre audit in Germany.
abstract: BACKGROUND
  The optimal treatment of asymptomatic carotid disease is being debated again. The conclusions of the large randomised controlled trials of the early 1980s and 1990s are increasingly being questioned due to advances in modern medical treatment. This study investigates how patients are actually managed medically related to general risk factors prior to carotid endarterectomy in a German health-care region.
  
  
  METHODS
  A prospective data bank including 95 consecutive patients was used. The effectiveness of lipid lowering and diabetes management were investigated as well as the use of anti-thrombotic and blood pressure medication.
  
  
  RESULTS
  A total of 108 carotid endarterectomies in 95 patients were performed between January 2009 and March 2010. All 95 patients (70 male, 25 female; 39 symptomatic/56 asymptomatic) were included in the study. Nearly half (54%) of the patients were on statins; of these, 45% had low-density lipoprotein (LDL) levels >100 mg dl(-1). Of 32 patients with diabetes, one had glycohaemoglobin (HbA(1c)) <6.0. Overall, four patients were on clopidogrel. Three patients were severely hypertensive (systolic blood pressure >180 mmHg).
  
  
  CONCLUSIONS
  The best medical therapy for carotid disease is not optimal in the part of the German health-care system observed in this study. We strongly advocate similar audits in other health-care areas and systems.
authors.affiliation: Department of Vascular and Endovascular Surgery, Verbundkrankenhaus Bernkastel/Wittlich, Koblenzerstr 91, 54516 Wittlich, Germany. h.lutz@verbund-krankenhaus.de
authors.forename: H J
authors.initials: HJ
authors.lastname: Lutz
authors.forename: R D
authors.initials: RD
authors.lastname: Sacuiu
authors.forename: B
authors.initials: B
authors.lastname: Gahl
authors.forename: H
authors.initials: H
authors.lastname: Savolainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D058070:Asymptomatic Diseases; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002340:Carotid Artery Diseases / Q000150:complications / Q000188:drug therapy*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control*; D016009:Chi-Square Distribution; D054869:Clinical Audit; D016894:Endarterectomy, Carotid; D019317:Evidence-Based Medicine; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents