Are patients receiving maximal medical therapy following carotid endarterectomy?

被引:17
作者
Betancourt, M
Van Stavern, RB
Share, D
Gardella, P
Martus, M
Chaturvedi, S
机构
[1] Wayne State Univ, Dept Neurol, Detroit, MI 48201 USA
[2] Wayne State Univ, Comprehens Stroke Program, Detroit, MI 48201 USA
[3] Michigan Ctr Hlth Care Qual & Evaluat Studies, Blue Cross & Blue Shield, Detroit, MI USA
关键词
D O I
10.1212/01.WNL.0000145841.96539.9B
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Most patients in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) did not receive lipid-lowering treatment. As vascular event rates can be lowered with statins, antihypertensive agents, and newer antiplatelet agents, the authors conducted a study to determine the usage of these medications in patients following carotid endarterectomy (CE). Methods: Claims data from Blue Cross and Blue Shield Michigan were used to study non-Medicare members who underwent CE in the years 1999 to 2001 ( n = 1,049). Prescription of pharmacotherapy and sustained use ( > 80% use of the follow-up period) were examined in the 365-day period following index CE. Results: Overall, 1,049 individuals underwent CE during the years 1999 to 2001. For the 1-year period following CE, the statin prescription rate was 70, 66, and 73% for the 3 study years. Sustained statin use was noted, on average, in 38%. The 3-year average was lower for sustained use of angiotensin-converting enzyme inhibitor (19%) and even lower for prescription antiplatelet agents (5%). Conclusions: Use of statins has increased following carotid endarterectomy ( CE) compared with the North American Symptomatic Carotid Endarterectomy Trial era, but sustained treatment with statins remains at < 40%. Recent studies have shown a decrease in vascular event rates with statins regardless of low-density lipoprotein level, suggesting that statin use should be routine following CE. Increased statin use as part of a multimodality intensive medical regimen following CE has the potential to improve long-term vascular event rates in this population.
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页码:2011 / 2015
页数:5
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