title: High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management.
abstract: Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown.
  
  
  
  Cross-sectional retrospective study.
  
  
  
  Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA).
  
  
  
  A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke.
  
  
  
  The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.
authors.affiliation: Department of Medicine and Health Sciences, Linköping University, Sweden elin.good@liu.se.
authors.forename: Elin
authors.initials: E
authors.lastname: Good
authors.affiliation: Department of Medicine and Health Sciences, Linköping University, Sweden.
authors.forename: Toste
authors.initials: T
authors.lastname: Länne
authors.affiliation: Department of Medicine and Health Sciences, Linköping University, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wilhelm
authors.affiliation: Department of Health and Caring Sciences, Linnaeus University, Sweden.
authors.forename: Joep
authors.initials: J
authors.lastname: Perk
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Medicine and Health Sciences, Linköping University, Sweden.
authors.forename: Ebo
authors.initials: E
authors.lastname: de Muinck
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology
keywords: High-grade carotid stenosis; atherosclerosis; cardiovascular disease; cardiovascular risk management; secondary prevention