Key result
Statin therapy did not significantly reduce the risk of major adverse cardiovascular and cerebrovascular events compared to no statin use in patients with low to moderate cardiovascular risk and non-obstructive carotid plaques (HR 0.95).
Why the study?
Discrepancies exist between risk assessed by clinical factors and vascular imaging, leaving unclear whether statins benefit low-to-moderate risk patients with carotid plaque.
Does statin therapy reduce MACCEs and all-cause mortality in patients with low to moderate cardiovascular risk and non-obstructive carotid plaques?
Cohort (n=806)
No
Does statin therapy reduce MACCEs and all-cause mortality in patients with low to moderate cardiovascular risk and non-obstructive carotid plaques?
Hazard Ratio: 0.95 (95% CI 0.45–2.03)
Absolute Event Rate: 5.7% vs 6.1%
p-value: p=0.90
No event reduction with statins; leaves open whether carotid plaque should guide therapy in low-moderate risk patients.
BACKGROUND AND OBJECTIVES: Some individuals exhibit discrepancies between risk classifications assessed using clinical factors and those obtained by vascular imaging. We aimed to evaluate whether statins provide clinical outcome benefits in patients classified as having low to moderate cardiovascular risk but with carotid plaque. METHODS: This was a retrospective propensity score matching study. A total of 12,158 consecutive patients undergoing carotid ultrasound between January 2012 to February 2020 were screened. Individuals with low to moderate cardiovascular risk who were not currently recommended for statin therapy but had carotid plaques were included. Among 1,611 enrolled individuals, 806 (statin group: 403, control group: 403) were analyzed. The primary outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs: cardiovascular death, myocardial infarction, coronary revascularization, and ischemic stroke or transient ischemic attack) and all-cause mortality. RESULTS: During the median follow-up of 6.0 years, the incidence of MACCEs did not differ between the groups (6.1 and 5.7/1,000 person-years in the control and statin groups, respectively; adjusted hazard ratio [HR], 0.95; p=0.90). The incidence of all-cause mortality did not differ (3.9 and 3.9/1,000 person-years, respectively; adjusted HR, 1.02; p=0.97). Kaplan-Meier curves revealed similar rates of MACCEs (log-rank p=0.72) and all-cause mortality (log-rank p=0.99) in the 2 groups. Age and smoking were independent predictors of MACCEs. Subgroups exhibited no differences in clinical outcomes with statin use. CONCLUSIONS: Benefit of statin therapy was likely to be limited in low to moderate risk patients with carotid plaques. These results could guide physicians in clinical decision-making regarding cardiovascular prevention.
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Yoon et al. (2022) conducted a cohort in Low to moderate cardiovascular risk with non-obstructive carotid plaques (n=806). Statin therapy vs. No statin therapy was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCEs) (HR 0.95, 95% CI 0.45-2.03, p=0.90). Statin therapy did not significantly reduce the risk of major adverse cardiovascular and cerebrovascular events compared to no statin use in patients with low to moderate cardiovascular risk and non-obstructive carotid plaques (HR 0.95).
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