Statin therapy in asymptomatic patients with carotid atherosclerosis and low to moderate calculated risk: results of a retrospective analysis

Abstract

Aim. The aim of the study was to assess the аdvisability of lipid-lowering therapy for primary cardiovascular prevention in asymptomatic patients, depending on the presence of subclinical carotid atherosclerosis.

Materials and methods. We examined 715 patients (302 men), mean age 54.6 ± 8.1 years old, with at least 1 traditional cardiovascular risk factor without manifested cardiovascular disease. Ultrasound examination of the carotid arteries was performed in all patients. Patients were divided into two groups: with statin therapy - statin+ (n = 184), without statin therapy - statin- (n = 531). Median of follow-up time was 4 years, (minimum 2 years, maximum 6). The endpoints included: a verified diagnosis of acute coronary syndrome, chronic coronary artery disease, planned coronary revascularization, ischemic stroke, and/or transient ischemic attack, cardiac death. Results. Nonstenotic atherosclerotic plaque (AP) of carotid arteries was detected in 325 patients (45%). 127 non-fatal events (17.8%) occurred during the follow-up. Patients who received statins had a significantly higher level of total cholesterol, higher prevalence of diabetes and AP and two times higher calculated SCORE risk. However, there were no significant differences between the statin+ and statin- groups in the number of events both initially (OR 0.91, 95% CI 0.56-1.45) and after the propensity score matching (OR 1.02, 95 % CI 0.75-1.98). This indicates the ineffectiveness of statin use in patients with a low risk without consideration of vascular imaging data. The incidence of endpoints without statins was significantly higher in patients with AP compared to patients without AP. There were no significant differences in patients with statin therapy. In patients with carotid AP who has low and high SCORE risk and did not receive statinsa a significant increase in the number of events was shown compared with patients of the same risk groups without AP, and there was absence of such difference in case of statin use.

Conclusion. Moderate statin therapy reduces the risk of non-fatal cardiovascular events in patients with “ low calculated risk and carotid AP.