Key result
Intensive lipid-lowering therapy achieves LDL targets in only ~33% of patients with >50% carotid stenosis.
Why the study?
What is the degree of LDL cholesterol control in patients with atherosclerotic carotid stenosis >50% or previous carotid intervention?
What is the degree of LDL cholesterol control in patients with atherosclerotic carotid stenosis >50% or previous carotid intervention?
Only 32.8% of patients with significant carotid stenosis or prior carotid intervention achieved the LDL-C goal of <55 mg/dL, indicating substantial residual cardiovascular risk and underuse of high-intensity statin therapy.
Suboptimal LDL control persists despite statins; leaves open whether intensified strategies improve real-world attainment.
BACKGROUND AND AIM Patients with atherosclerotic carotid disease are at very high cardiovascular risk and often have other vascular territories involved. The main objective of the present study was to assess the degree of LDL cholesterol control in patients with carotid stenosis>50%. Secondary objectives included prescribed lipid-lowering drugs and factors associated with the use of high/very high-intensity lipid-lowering therapy. METHODS AND RESULTS Consecutive patients who underwent carotid Doppler ultrasound between March 2023 and February 2024 due to a previous endarterectomy or stenting, as well as those with ultrasound findings of stenosis>50%, were included. Clinical, analytical and pharmacological data were collected. LDL-C levels were categorized as <55mg/dL, 55-69mg/dL, and ≥70mg/dL. Multivariable logistic regression was performed to identify factors associated with the use of high- or very high-intensity lipid-lowering therapy. Four hundred patients (mean age 71.7; 77% male) were included. LDL cholesterol<55mg/dL was achieved in 131 (32.8%) of patients. Of the total sample, 259 (64.8%) were on high or very high-intensity therapy. When stratified by LDL-C levels, 32.8% had LDL-C<55mg/dL, 22.2% between 55 and 69mg/dL, and 45.0% ≥70mg/dL. Patients with a concomitant coronary heart disease (n=106, 26.5%) showed a greater rate of LDL cholesterol control (OR=3.1, p<0.001), and those with a history of transient ischemic attack or stroke (OR=1.7, p=0.039 and OR=1.8, p=0.023, respectively), but not those with peripheral arterial disease. CONCLUSION In the present study, LDL cholesterol goal was achieved in one in every three patients with atherosclerotic carotid stenosis>50%. Consequently, a substantial residual cardiovascular risk persists in many patients. This gap, and the underuse of high-intensity statin therapy, highlights an important opportunity to improve cardiovascular prevention.
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García et al. (2026) studied this question. Patients with atherosclerotic carotid stenosis >50% achieved the LDL cholesterol target of <55 mg/dL in only 32.8% of cases, despite 64.8% receiving high- or very high-intensity therapy.
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