Long-term mortality in patients with asymptomatic carotid stenosis: Implications for statin therapy

Argyrios Giannopoulos, Stavros K Kakkos, A. Abbott, A Ross Naylor, T. Richards, Dimitri P Mikhailidis, George Geroulakos, A. N. Nicolaides

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Objective Recent studies with asymptomatic carotid patients on best medical management have shown that the annual risk of stroke has decreased to approximately 1%. There is no evidence that a similar decrease in mortality has occurred. In addition, the intensity of statin therapy for these patients has not yet been determined. The aims of this review were to determine (a) the reported long-term all-cause and cardiac-related mortality in patients with asymptomatic carotid stenosis (ACS) > 50%, (b) whether there has been a decrease in mortality in recent years, (c) the available methods of mortality risk stratification, and (d) whether the latest ACC/AHA guidelines on the treatment of serum lipids can be applied to this group of patients. Methods Systematic review of PubMed, EuroPubMed, and Cochrane Library and meta-analysis using random effects for pooled proportions were performed regarding long-term all-cause and cardiac-related mortality and the associated risk factors in ACS patients. The last day for literature search was October 30, 2014. Results Seventeen studies were retrieved reporting 5-year all-cause mortality in 11,391 patients with ACS >50%. The 5-year cumulative all-cause mortality across all 17 studies was 23.6% (95% CI 20.50-26.80). Twelve additional studies, reporting both all-cause and cardiac mortality with a minimum of 2 year follow-up and involving 4,072 patients were identified. Of the 930 deaths reported, 589 (62.9%; 95% CI 58.81-66.89) were cardiac-related. This translates into an average cardiac-related mortality of 2.9% per year. Conclusions All-cause and cardiac mortality in ACS patients are very high. Although risk stratification is possible, most patients are classified as high risk. In view of this high risk, aggressive statin therapy is indicated if the new ACC/AHA guidelines on serum lipids are to be adhered to.

Original languageEnglish
Pages (from-to)573-582
Number of pages10
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume50
Issue number5
DOIs
Publication statusPublished - 1 Nov 2015

Keywords

  • All-cause mortality
  • Asymptomatic carotid stenosis
  • Cardiac-related mortality
  • Statin therapy

Cite this

Giannopoulos, Argyrios ; Kakkos, Stavros K ; Abbott, A. ; Naylor, A Ross ; Richards, T. ; Mikhailidis, Dimitri P ; Geroulakos, George ; Nicolaides, A. N. / Long-term mortality in patients with asymptomatic carotid stenosis : Implications for statin therapy. In: European Journal of Vascular and Endovascular Surgery. 2015 ; Vol. 50, No. 5. pp. 573-582.
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title = "Long-term mortality in patients with asymptomatic carotid stenosis: Implications for statin therapy",
abstract = "Objective Recent studies with asymptomatic carotid patients on best medical management have shown that the annual risk of stroke has decreased to approximately 1{\%}. There is no evidence that a similar decrease in mortality has occurred. In addition, the intensity of statin therapy for these patients has not yet been determined. The aims of this review were to determine (a) the reported long-term all-cause and cardiac-related mortality in patients with asymptomatic carotid stenosis (ACS) > 50{\%}, (b) whether there has been a decrease in mortality in recent years, (c) the available methods of mortality risk stratification, and (d) whether the latest ACC/AHA guidelines on the treatment of serum lipids can be applied to this group of patients. Methods Systematic review of PubMed, EuroPubMed, and Cochrane Library and meta-analysis using random effects for pooled proportions were performed regarding long-term all-cause and cardiac-related mortality and the associated risk factors in ACS patients. The last day for literature search was October 30, 2014. Results Seventeen studies were retrieved reporting 5-year all-cause mortality in 11,391 patients with ACS >50{\%}. The 5-year cumulative all-cause mortality across all 17 studies was 23.6{\%} (95{\%} CI 20.50-26.80). Twelve additional studies, reporting both all-cause and cardiac mortality with a minimum of 2 year follow-up and involving 4,072 patients were identified. Of the 930 deaths reported, 589 (62.9{\%}; 95{\%} CI 58.81-66.89) were cardiac-related. This translates into an average cardiac-related mortality of 2.9{\%} per year. Conclusions All-cause and cardiac mortality in ACS patients are very high. Although risk stratification is possible, most patients are classified as high risk. In view of this high risk, aggressive statin therapy is indicated if the new ACC/AHA guidelines on serum lipids are to be adhered to.",
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author = "Argyrios Giannopoulos and Kakkos, {Stavros K} and A. Abbott and Naylor, {A Ross} and T. Richards and Mikhailidis, {Dimitri P} and George Geroulakos and Nicolaides, {A. N.}",
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Giannopoulos, A, Kakkos, SK, Abbott, A, Naylor, AR, Richards, T, Mikhailidis, DP, Geroulakos, G & Nicolaides, AN 2015, 'Long-term mortality in patients with asymptomatic carotid stenosis: Implications for statin therapy' European Journal of Vascular and Endovascular Surgery, vol. 50, no. 5, pp. 573-582. https://doi.org/10.1016/j.ejvs.2015.06.115

Long-term mortality in patients with asymptomatic carotid stenosis : Implications for statin therapy. / Giannopoulos, Argyrios; Kakkos, Stavros K; Abbott, A.; Naylor, A Ross; Richards, T.; Mikhailidis, Dimitri P; Geroulakos, George; Nicolaides, A. N.

In: European Journal of Vascular and Endovascular Surgery, Vol. 50, No. 5, 01.11.2015, p. 573-582.

Research output: Contribution to journalReview ArticleResearchpeer-review

TY - JOUR

T1 - Long-term mortality in patients with asymptomatic carotid stenosis

T2 - Implications for statin therapy

AU - Giannopoulos, Argyrios

AU - Kakkos, Stavros K

AU - Abbott, A.

AU - Naylor, A Ross

AU - Richards, T.

AU - Mikhailidis, Dimitri P

AU - Geroulakos, George

AU - Nicolaides, A. N.

PY - 2015/11/1

Y1 - 2015/11/1

N2 - Objective Recent studies with asymptomatic carotid patients on best medical management have shown that the annual risk of stroke has decreased to approximately 1%. There is no evidence that a similar decrease in mortality has occurred. In addition, the intensity of statin therapy for these patients has not yet been determined. The aims of this review were to determine (a) the reported long-term all-cause and cardiac-related mortality in patients with asymptomatic carotid stenosis (ACS) > 50%, (b) whether there has been a decrease in mortality in recent years, (c) the available methods of mortality risk stratification, and (d) whether the latest ACC/AHA guidelines on the treatment of serum lipids can be applied to this group of patients. Methods Systematic review of PubMed, EuroPubMed, and Cochrane Library and meta-analysis using random effects for pooled proportions were performed regarding long-term all-cause and cardiac-related mortality and the associated risk factors in ACS patients. The last day for literature search was October 30, 2014. Results Seventeen studies were retrieved reporting 5-year all-cause mortality in 11,391 patients with ACS >50%. The 5-year cumulative all-cause mortality across all 17 studies was 23.6% (95% CI 20.50-26.80). Twelve additional studies, reporting both all-cause and cardiac mortality with a minimum of 2 year follow-up and involving 4,072 patients were identified. Of the 930 deaths reported, 589 (62.9%; 95% CI 58.81-66.89) were cardiac-related. This translates into an average cardiac-related mortality of 2.9% per year. Conclusions All-cause and cardiac mortality in ACS patients are very high. Although risk stratification is possible, most patients are classified as high risk. In view of this high risk, aggressive statin therapy is indicated if the new ACC/AHA guidelines on serum lipids are to be adhered to.

AB - Objective Recent studies with asymptomatic carotid patients on best medical management have shown that the annual risk of stroke has decreased to approximately 1%. There is no evidence that a similar decrease in mortality has occurred. In addition, the intensity of statin therapy for these patients has not yet been determined. The aims of this review were to determine (a) the reported long-term all-cause and cardiac-related mortality in patients with asymptomatic carotid stenosis (ACS) > 50%, (b) whether there has been a decrease in mortality in recent years, (c) the available methods of mortality risk stratification, and (d) whether the latest ACC/AHA guidelines on the treatment of serum lipids can be applied to this group of patients. Methods Systematic review of PubMed, EuroPubMed, and Cochrane Library and meta-analysis using random effects for pooled proportions were performed regarding long-term all-cause and cardiac-related mortality and the associated risk factors in ACS patients. The last day for literature search was October 30, 2014. Results Seventeen studies were retrieved reporting 5-year all-cause mortality in 11,391 patients with ACS >50%. The 5-year cumulative all-cause mortality across all 17 studies was 23.6% (95% CI 20.50-26.80). Twelve additional studies, reporting both all-cause and cardiac mortality with a minimum of 2 year follow-up and involving 4,072 patients were identified. Of the 930 deaths reported, 589 (62.9%; 95% CI 58.81-66.89) were cardiac-related. This translates into an average cardiac-related mortality of 2.9% per year. Conclusions All-cause and cardiac mortality in ACS patients are very high. Although risk stratification is possible, most patients are classified as high risk. In view of this high risk, aggressive statin therapy is indicated if the new ACC/AHA guidelines on serum lipids are to be adhered to.

KW - All-cause mortality

KW - Asymptomatic carotid stenosis

KW - Cardiac-related mortality

KW - Statin therapy

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U2 - 10.1016/j.ejvs.2015.06.115

DO - 10.1016/j.ejvs.2015.06.115

M3 - Review Article

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