The efficacy of statin therapy in patients with acute coronary syndromes and concomitant carotid disease

Abstract

Background: Statins prevent recurrent ischemic coronary events after acute coronary syndrome (ACS) and improve cardiovascular outcome of patientswith peripheral artery disease. Aim:We sought to evaluate the interrelationship between statin use, phenotype of carotid plaques as assessed by ultrasound, and outcome of patientswith ACS and concomitant carotid disease. Methods: A total of 337 consecutive patients with ACS were assessed by coronary angiography and Doppler ultrasound of the carotid arteries and followed up for a median period of 19 months. Results: Carotid plaques were detected in 144 (42%) patients. Of these patients, 99 (69%) had echogenic carotid plaques and 45 (31%) had echolucent plaques. The groups did not differ significantly with regard to the lipid profiles, the prevalence of risk factors, and 1-vessel, 2-vessel, or 3-vessel coronary artery disease. During follow-up, 227 (67%) patientswere receiving statins. We observed 14 cardiac deaths and 17myocardial infarctions. After adjustment for treatment strategy (medical therapy ormyocardial revascularization), patients with echolucent carotid plaques receiving statin therapy (n= 32, 71%) showed a better event-free survival than did patients with echolucent plaques not treatedwith statins (log-rank P = .038). In patients with echogenic carotid plaques, the benefit of statin therapy on event-free survivalwas less evident (log-rank P = .56). Conclusion: In patientswith ACS and echolucent carotid plaques, statin therapy is associatedwith better eventfree survival,while in patientswith ACS and echogenic carotid plaques no clear benefit of statins is observed. © 2010 Wiley Periodicals, Inc.