Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease

Paraskevas, Kosmas I.;Gloviczki, Peter;Antignani, Pier Luigi;Comerota, Anthony J.;Dardik, Alan;Davies, Alun H.;Eckstein, Hans Henning;Faggioli, Gianluca;Fernandes e Fernandes, Jose;Fraedrich, Gustav;Geroulakos, George;Golledge, Jonathan;Gupta, Ajay;Gurevich, Victor S.;Jawien, Arkadiusz;Jezovnik, Mateja K.;Kakkos, Stavros K.;Knoflach, Michael;Lanza, Gaetano;Liapis, Christos D.;Loftus, Ian M.;Mansilha, Armando;Nicolaides, Andrew N.;Pini, Rodolfo;Poredos, Pavel;Proczka, Robert M.;Ricco, Jean Baptiste;Rundek, Tatjana;Saba, Luca;Schlachetzki, Felix;Silvestrini, Mauro;Spinelli, Francesco;Stilo, Francesco;Suri, Jasjit S.;Svetlikov, Alexei V.;Zeebregts, Clark J.;Chaturvedi, Seemant;Veith, Frank J.;Mikhailidis, Dimitri P.

Jonathan Golledge

Abstract

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.

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Progress in Cardiovascular Diseases

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1873-1740

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Elsevier

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DOI

10.1016/j.pcad.2022.05.003