The Effect of Statin Use and Intensity After Carotid Endarterectomy

Statin use in patients undergoing carotid endarterectomy (CEA) has been advocated for prevention of postoperative and future stroke and myocardial infarction (MI). However, the effect of duration and intensity of statin therapy on outcomes after CEA has not been investigated. Optum Labs Data Warehouse, a large database containing administrative claims on privately insured and Medicare Advantage enrollees, was used to analyze the rates of stroke, MI, and statin use after CEA. Both duration of statin therapy and use of high-intensity therapy were investigated. There were 21,465 patients identified who underwent CEA from 2004 to 2014. Average age was 70 years, and 59.2% were male. Follow-up was a median 2 years (range, 0.2-10 years). Statin therapy was prescribed at discharge in 85.5% of patients. The 30-day and 90-day stroke rates were 1.3% and 2.1%, respectively, and MI rates were 0.4% and 1.1%, respectively. Postoperative statin use did not show a statistically significant effect on stroke outcomes at 30 days (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.59-1.02; P = .07) or 90 days (OR, 1.1; 95% CI, 0.9-1.34; P = .36) or on MI rates at 30 days (OR, 1.0; 95% CI, 0.67-1.51; P = .98) or 90 days (OR, 1.02; 95% CI, 0.78-1.34; P = .89) after CEA. High-intensity statin use did not show an effect on 30-day (OR, 1.02; 95% CI, 0.55-1.91; P = .94) or 90-day (OR, 1.06; 95% CI, 0.75-1.5; P = .73) stroke outcomes or 30-day (OR, 0.79; 95% CI, 0.3-2.1; P = .63) or 90-day (OR, 1.33; 95% CI, 0.84-2.09; P = .22) MI rates. Long-term statin use was seen in 62.6%. Statin use was independently protective against long-term stroke (hazard ratio, 0.82; 95% CI, 0.74-0.91; P < .001) and MI (hazard ratio, 0.8; 95% CI, 0.72-0.89; P < .001). Post-CEA statin therapy was not associated with a decreased risk of stroke or MI at 30 or 90 days. It is, however, associated with a long-term protective effect against MI and stroke. High-intensity statin use compared with standard use did not show an effect on stroke or MI at 30 and 90 days after CEA.