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Lipid goal achievement and trends in lipid-lowering therapy in veterans undergoing carotid endarterectomy

Department of Surgery, VA Connecticut Healthcare System, West Haven, CT and Yale University School of Medicine, New Haven, CT, USA

Cathy Popp

Department of Medicine, VA Connecticut Healthcare System, West Haven, CT and Yale University School of Medicine, New Haven, CT, USA

Alan Dardik

Department of Surgery, VA Connecticut Healthcare System, West Haven, CT and Yale University School of Medicine, New Haven, CT, USA

Daniel G Federman

Department of Medicine, VA Connecticut Healthcare System, West Haven, CT and Yale University School of Medicine, New Haven, CT, USA

Abstract

Secondary prevention of cardiovascular disease after carotid endarterectomy should include management of low-density lipoprotein (LDL) levels, but increased LDL levels are undertreated in these patients. We examined trends in statin use and LDL goal achievement in veterans undergoing carotid endarterectomy (CEA), a medically high-risk group with high rates of cardiovascular morbidity and mortality. The records of all CEA performed between 1995 and 2005 in the Connecticut Veterans’ Affairs (VA) hospital were reviewed. Kaplan-Meier analysis was used to analyze long-term outcomes. ANOVA was used for comparisons between groups. A total of 309 CEA procedures were performed in 298 patients. The mean follow-up was 4.1 years. Statin use increased over time (12% in 1995, 84% in 2005) and mean LDL levels decreased (105 mg/dl in 1997, 90 mg/dl in 2007). The number of patients achieving LDL goals of 100 mg/dl or 70 mg/dl increased. Mean HDL levels decreased (53 mg/dl in 1997 and 38 mg/dl in 2007). Patients with three or more comorbid medical conditions were more likely to achieve LDL goals. At 12 years, freedom from stroke was 91%, freedom from myocardial infarction was 46% and survival was 12%. In conclusion, over the last decade, among patients who have undergone CEA, statin use has increased and LDL levels have improved.

Key Words: endarterectomy • high-risk • hyperlipidemia • low-density lipoprotein • peripheral arterial disease

Vascular Medicine, Vol. 14, No. 1, 21-27 (2009)
DOI: 10.1177/1358863X08098271


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