TY - JOUR
T1 - Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease
AU - Paraskevas, Kosmas I.
AU - Gloviczki, Peter
AU - Antignani, Pier Luigi
AU - Comerota, Anthony J.
AU - Dardik, Alan
AU - Davies, Alun H.
AU - Eckstein, Hans Henning
AU - Faggioli, Gianluca
AU - Fernandes e Fernandes, Jose
AU - Fraedrich, Gustav
AU - Geroulakos, George
AU - Golledge, Jonathan
AU - Gupta, Ajay
AU - Gurevich, Victor S.
AU - Jawien, Arkadiusz
AU - Jezovnik, Mateja K.
AU - Kakkos, Stavros K.
AU - Knoflach, Michael
AU - Lanza, Gaetano
AU - Liapis, Christos D.
AU - Loftus, Ian M.
AU - Mansilha, Armando
AU - Nicolaides, Andrew N.
AU - Pini, Rodolfo
AU - Poredos, Pavel
AU - Proczka, Robert M.
AU - Ricco, Jean Baptiste
AU - Rundek, Tatjana
AU - Saba, Luca
AU - Schlachetzki, Felix
AU - Silvestrini, Mauro
AU - Spinelli, Francesco
AU - Stilo, Francesco
AU - Suri, Jasjit S.
AU - Svetlikov, Alexei V.
AU - Zeebregts, Clark J.
AU - Chaturvedi, Seemant
AU - Veith, Frank J.
AU - Mikhailidis, Dimitri P.
N1 - Funding Information:
Dimitri P. Mikhailidis has given talks, acted as a Consultant or attended conferences sponsored by Amgen and Novo Nordisk. Jonathan Golledge has received honoraria for speaking by Amgen and Bayer. Seemant Chaturvedi is a Consultant to Astra Zeneca. The other authors have no conflicts of interest.
Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - 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.
AB - 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.
KW - Best medical treatment
KW - Carotid artery stenosis
KW - Carotid artery stenting
KW - Carotid endarterectomy
KW - Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors
KW - Statins
U2 - 10.1016/j.pcad.2022.05.003
DO - 10.1016/j.pcad.2022.05.003
M3 - Review article
C2 - 35605696
AN - SCOPUS:85130960625
SN - 0033-0620
VL - 73
SP - 41
EP - 47
JO - Progress in cardiovascular diseases
JF - Progress in cardiovascular diseases
ER -