October 23, 2006 (Salt Lake City, UT) – Statins are highly effective in preventing new stroke or MI in patients with severe carotid arterial disease, a new study shows [1].

The results indicate that all patients with this disease at high risk of another event should be treated with statins, regardless of whether or not they have hypercholesterolemia, lead investigator Dr Gautham Ravipati (New York Medical College, Valhalla) told heartwire .

He presented the findings of the study today at the CHEST 2006 meeting (annual meeting of the American College of Chest Physicians).

Many with high cholesterol still not on statins

From January 2001 to December 2005, Ravipati and his colleagues analyzed the charts of 449 patients with carotid arterial disease, all of whom had experienced a narrowing of one or two carotid arteries but had either refused revascularization or were deemed unsuitable candidates.

Of the 449 patients, 298 (66%) were treated with statins and 151 were not. Follow-up occurred within a mean of 26 months for the statin group and 21 months for the control group.

The researchers identified hypercholesterolemia in all 298 (100%) patients treated with statins and in 145 of 151 (96%) of those not treated with statins.

"We were shocked at how many patients with high cholesterol were still not treated with statins," Ravipati commented.

The incidence of new stroke, new MI, or death in patients on statins in the study was 15% compared with 68% in those not treated with statins (p<0.001).

Independent predictors for the time to development of new stroke, new MI, or death included use of statins, diabetes, and prior events, but interestingly not hypercholesterolemia. "We were very surprised that cholesterol was not an independent risk factor," Ravipati noted.

Independent predictors of time to development of new stroke, MI, or death in patients with carotid arterial disease
Risk ratio
Use of statins
Systemic hypertension
Diabetes mellitus
Prior stroke
Prior MI

Treat high-risk patients, even if cholesterol is normal

"This indicates that we should aggressively treat these patients even if their cholesterol is normal," says Ravipati. "Of course, statins will never take away from good risk-factor modification," he stressed, adding that those particularly at risk include diabetics and people who have already had a TIA, stroke, or MI.
"But there is an underutilization of statins. The message should be: 'Don't start a statin based on the cholesterol. Start it independently.' If a patient has had an event but his cholesterol seems 'normal,' his level is probably not 'normal' for him."

Reassuringly, none of the patients taking statins had hemorrhagic strokes, Ravipati said.

He believes some of the benefits of statins in this population are likely independent of their cholesterol-lowering effects. So-called pleiotropic effects such as anti-inflammatory, antioxidant, and possibly antithrombotic effects of statins, as well as a beneficial effect of the drugs on endothelial function, could play a role, he noted.
  1. Ravipati G, Aronow WS, Ahn C, et al. Reduction of myocardial infarction or stroke or all-cause mortality in patients with carotid arterial disease treated with statins. CHEST 2006; October 21-26, 2006; Salt Lake City, UT. Abstract 3651.

The complete contents of Heartwire , a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.


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