title: Role of statin therapy and angiotensin blockade in patients with asymptomatic moderate carotid artery stenosis.
abstract: BACKGROUND
  The purpose of this study was to evaluate the 10-year outcome of patients presenting with asymptomatic moderate carotid artery stenosis, and to determine which factors correlate with progression of disease to stroke or revascularization.
  
  
  METHODS
  A retrospective review of all new patients presenting with asymptomatic moderate carotid artery stenosis from July 1998 to December 2001 was undertaken. Patients were consecutively identified and included by using duplex ultrasonography to identify moderate carotid disease. Variables were recorded for all patient encounters through June 2010. The primary end point was occurrence of ipsilateral cerebrovascular stroke or revascularization event (SORE). Statin therapy and angiotensin blockade (STAB) were categorized as follows: STAB(0)-medical treatment with neither statin therapy nor angiotensin blockade, STAB(1)-treatment with only one of the two, STAB(2)-treatment with both. An amortized cost model analyzed the cost of SORE-free survival.
  
  
  RESULTS
  Over a 42-month period, 468 carotids in 366 patients with an average age of 69.0 ± 8.7 years were evaluated. Over a mean follow-up of 6.6 ± 2.7 years, SORE occurred in 150 (32.1%) carotid arteries. Hyperlipidemia was predictive of SORE (hazard ratio [HR]: 1.543, 95% confidence interval [CI]: 1.053-2.262, P = 0.03). Medical therapies protective against SORE were beta-blockade (HR: 0.612, 95% CI: 0.435-0.861, P < 0.05), STAB(1) (HR: 0.487, 95% CI: 0.336-0.706, P < 0.01), and STAB(2) (HR: 0.149, 95% CI: 0.089-0.248, P < 0.01). At 10 years, SORE-free survival in STAB(2) was 82.7% ± 4.6%, STAB(1) was 56.3% ± 5.0%, and STAB(0) was 29.3% ± 5.4% (P < 0.01). The cost per SORE-free year in STAB(2) was $1,695.40 ± $275.60, STAB(1) was $3,916.80 ± $605.44, and STAB(0) was $4,126.40 ± $427.23 (P < 0.01).
  
  
  CONCLUSIONS
  These data demonstrate the clinical and financial advantage of using both statin therapy and angiotensin pathway blockage in patients with asymptomatic moderate carotid artery stenosis.
authors.affiliation: Department of Surgery, East Carolina University, Greenville, NC 27858-4354, USA. durhamch@ecu.edu
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Durham
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Ehlert
authors.forename: Steven C
authors.initials: SC
authors.lastname: Agle
authors.forename: Ashley C
authors.initials: AC
authors.lastname: Mays
authors.forename: Frank M
authors.initials: FM
authors.lastname: Parker
authors.forename: William M
authors.initials: WM
authors.lastname: Bogey
authors.forename: Charles S
authors.initials: CS
authors.lastname: Powell
authors.forename: Michael C
authors.initials: MC
authors.lastname: Stoner
mesh_terms: D000368:Aged; D017130:Angioplasty; D047228:Angiotensin II Type 1 Receptor Blockers / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000401:mortality / Q000601:surgery; D003362:Cost-Benefit Analysis; D018450:Disease Progression; D018572:Disease-Free Survival; D016527:Drug Costs; D004359:Drug Therapy, Combination; D016894:Endarterectomy, Carotid; D005260:Female; D017048:Health Care Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009657:North Carolina; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors