Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

Kosmas I Paraskevas¹, Peter Gloviczki², Pier Luigi Antignani³, Anthony J Comerota⁴, Alan Dardik⁵, Alun H Davies⁶, Hans-Henning Eckstein⁷, Gianluca Faggioli⁸, Jose Fernandes E Fernandes⁹, Gustav Fraedrich¹⁰, George Geroulakos¹¹, Jonathan Golledge¹², Ajay Gupta¹³, Victor S Gurevich¹⁴, Arkadiusz Jawien¹⁵, Mateja K Jezovnik¹⁶, Stavros K Kakkos¹⁷, Michael Knoflach¹⁸, Gaetano Lanza¹⁹, Christos D Liapis²⁰, Ian M Loftus²¹, Armando Mansilha²², Andrew N Nicolaides²³, Rodolfo Pini⁸, Pavel Poredos²⁴, Robert M Proczka²⁵, Jean-Baptiste Ricco²⁶, Tatjana Rundek²⁷, Luca Saba²⁸, Felix Schlachetzki²⁹, Mauro Silvestrini³⁰, Francesco Spinelli³¹, Francesco Stilo³¹, Jasjit S Suri³², Alexei V Svetlikov³³, Clark J Zeebregts³⁴, Seemant Chaturvedi³⁵, Frank J Veith³⁶, Dimitri P Mikhailidis³⁷

Affiliations

¹ Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece. Electronic address: paraskevask@hotmail.com.
² Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
³ Vascular Centre, Nuova Villa Claudia, Rome, Italy.
⁴ Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, VA, USA.
⁵ Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁶ Section of Vascular Surgery, Imperial College & Imperial Healthcare NHS Trust, London, UK.
⁷ Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
⁸ Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
⁹ Department of Vascular Surgery, University of Lisbon, Lisbon Academic Medical Center, Lisbon, Portugal.
¹⁰ Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
¹¹ Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹² Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Townsville, Queensland, Australia.
¹³ Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
¹⁴ Center of Atherosclerosis and Lipid Disorders, Saint-Petersburgh State University, North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburgh, Russia.
¹⁵ Department for Vascular Surgery and Angiology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
¹⁶ Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA.
¹⁷ Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
¹⁸ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
¹⁹ Vascular Surgery Department, IRCSS MultiMedica Hospital, Castellanza, Italy.
²⁰ Athens Vascular Research Center, Athens, Greece.
²¹ St. George's Vascular Institute, St. George's University London, London, UK.
²² Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal.
²³ Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus.
²⁴ Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia.
²⁵ 1(st) Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland.
²⁶ Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France.
²⁷ Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
²⁸ Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy.
²⁹ Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Regensburg, Germany.
³⁰ Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
³¹ Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy.
³² Stroke Diagnostic and Monitoring Division, Atheropoint™, Roseville, CA, USA.
³³ Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St. Petersburgh, Russia.
³⁴ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³⁵ Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA.
³⁶ Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA; Division of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
³⁷ Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.

PMID: 35605696
DOI: 10.1016/j.pcad.2022.05.003

Review

Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

Kosmas I Paraskevas et al. Prog Cardiovasc Dis. 2022 Jul-Aug.

. 2022 Jul-Aug:73:41-47.

doi: 10.1016/j.pcad.2022.05.003. Epub 2022 May 20.

Authors

Affiliations

¹ Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece. Electronic address: paraskevask@hotmail.com.
² Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA.
³ Vascular Centre, Nuova Villa Claudia, Rome, Italy.
⁴ Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, VA, USA.
⁵ Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁶ Section of Vascular Surgery, Imperial College & Imperial Healthcare NHS Trust, London, UK.
⁷ Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
⁸ Vascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
⁹ Department of Vascular Surgery, University of Lisbon, Lisbon Academic Medical Center, Lisbon, Portugal.
¹⁰ Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
¹¹ Department of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹² Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Townsville, Queensland, Australia.
¹³ Department of Radiology, Weill Cornell Medicine, New York, NY, USA.
¹⁴ Center of Atherosclerosis and Lipid Disorders, Saint-Petersburgh State University, North-Western State Medical University n.a. I.I. Mechnikov, St. Petersburgh, Russia.
¹⁵ Department for Vascular Surgery and Angiology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
¹⁶ Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA.
¹⁷ Department of Vascular Surgery, University of Patras Medical School, Patras, Greece.
¹⁸ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
¹⁹ Vascular Surgery Department, IRCSS MultiMedica Hospital, Castellanza, Italy.
²⁰ Athens Vascular Research Center, Athens, Greece.
²¹ St. George's Vascular Institute, St. George's University London, London, UK.
²² Faculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal.
²³ Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus.
²⁴ Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia.
²⁵ 1(st) Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland.
²⁶ Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France.
²⁷ Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA.
²⁸ Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy.
²⁹ Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Regensburg, Germany.
³⁰ Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy.
³¹ Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy.
³² Stroke Diagnostic and Monitoring Division, Atheropoint™, Roseville, CA, USA.
³³ Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St. Petersburgh, Russia.
³⁴ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
³⁵ Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA.
³⁶ Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA; Division of Vascular Surgery, Cleveland Clinic, Cleveland, OH, USA.
³⁷ Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.

PMID: 35605696
DOI: 10.1016/j.pcad.2022.05.003

Abstract

International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C with statins or non-statin medications for Asx/SCS patients. The cerebrovascular and CV beneficial effects associated with statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and other non-statin lipid-lowering agents (e.g. fibrates, ezetimibe) are reviewed. The use of statins and PCSK9 inhibitors is associated with several beneficial effects for Asx/SCS patients, including carotid plaque stabilization and reduction of stroke rates. Ezetimibe and fibrates are associated with smaller reductions in stroke rates. The side-effects resulting from statin and PCSK9 inhibitor use are also highlighted. The benefits associated with lowering LDL-C with statins or non-statin lipid lowering agents (e.g. PCSK9 inhibitors) outweigh the risks and potential side-effects. Irrespective of their LDL-C levels, all Asx/SCS patients should receive high-dose statin treatment±ezetimibe or PCSK9 inhibitors for reduction not only of LDL-C levels, but also of stroke, cardiovascular mortality and coronary event rates.

Keywords: Best medical treatment; Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy; Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors; Statins.

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Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

Affiliations

Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous