Are patients receiving maximal medical therapy following carotid endarterectomy?

M. Betancourt, R. B. Van Stavern, D. Share, P. Gardella, M. Martus, Seemant Chaturvedi

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2011-2015
Number of pages5
JournalNeurology
Volume63
Issue number11
StatePublished - Dec 14 2004
Externally publishedYes

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Carotid Endarterectomy
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Blue Cross Blue Shield Insurance Plans
Prescriptions
Blood Vessels
Therapeutics
Platelet Aggregation Inhibitors
LDL Lipoproteins
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Lipids
Drug Therapy

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Betancourt, M., Van Stavern, R. B., Share, D., Gardella, P., Martus, M., & Chaturvedi, S. (2004). Are patients receiving maximal medical therapy following carotid endarterectomy? Neurology, 63(11), 2011-2015.

Are patients receiving maximal medical therapy following carotid endarterectomy? / Betancourt, M.; Van Stavern, R. B.; Share, D.; Gardella, P.; Martus, M.; Chaturvedi, Seemant.

In: Neurology, Vol. 63, No. 11, 14.12.2004, p. 2011-2015.

Research output: Contribution to journalArticle

Betancourt, M, Van Stavern, RB, Share, D, Gardella, P, Martus, M & Chaturvedi, S 2004, 'Are patients receiving maximal medical therapy following carotid endarterectomy?', Neurology, vol. 63, no. 11, pp. 2011-2015.
Betancourt M, Van Stavern RB, Share D, Gardella P, Martus M, Chaturvedi S. Are patients receiving maximal medical therapy following carotid endarterectomy? Neurology. 2004 Dec 14;63(11):2011-2015.
Betancourt, M. ; Van Stavern, R. B. ; Share, D. ; Gardella, P. ; Martus, M. ; Chaturvedi, Seemant. / Are patients receiving maximal medical therapy following carotid endarterectomy?. In: Neurology. 2004 ; Vol. 63, No. 11. pp. 2011-2015.
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abstract = "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.",
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