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From the Department of Neurology and Comprehensive Stroke Program (Drs. Van Stavern and Chaturvedi), Wayne State University, and Blue Cross and Blue Shield of Michigan Center for Health Care Quality & Evaluative Studies (Drs. Betancourt and Share, P. Gardella and M. Martus), Detroit.
Address correspondence and reprint requests to Dr. S. Chaturvedi, Department of Neurology, Wayne State University, 8C-UHC, 4201 St. Antoine, Detroit, MI 48201; e-mail: Schaturv{at}med.wayne.edu
Background: Most patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) did not receive lipid-lowering treatment. As vascular event rates can be lowered with statins, antihypertensive agents, and newer antiplatelet agents, the authors conducted a study to determine the usage of these medications in patients following carotid endarterectomy (CE).
Methods: Claims data from Blue Cross and Blue Shield Michigan were used to study non-Medicare members who underwent CE in the years 1999 to 2001 (n = 1,049). Prescription of pharmacotherapy and sustained use (>80% use of the follow-up period) were examined in the 365-day period following index CE.
Results: Overall, 1,049 individuals underwent CE during the years 1999 to 2001. For the 1-year period following CE, the statin prescription rate was 70, 66, and 73% for the 3 study years. Sustained statin use was noted, on average, in 38%. The 3-year average was lower for sustained use of angiotensin-converting enzyme inhibitor (19%) and even lower for prescription antiplatelet agents (5%).
Conclusions: Use of statins has increased following carotid endarterectomy (CE) compared with the North American Symptomatic Carotid Endarterectomy Trial era, but sustained treatment with statins remains at <40%. Recent studies have shown a decrease in vascular event rates with statins regardless of low-density lipoprotein level, suggesting that statin use should be routine following CE. Increased statin use as part of a multimodality intensive medical regimen following CE has the potential to improve long-term vascular event rates in this population.
Received February 27, 2004. Accepted in final form July 29, 2004.
Related Article
Neurology 2004 63: 1992-1993.
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