Benefits and drawbacks of statins and non-statin lipid lowering agents in carotid artery disease.

Paraskevas, Kosmas I; Gloviczki, Peter; Antignani, Pier Luigi; Comerota, Anthony J; Dardik, Alan; Davies, Alun H; Eckstein, Hans-Henning; Faggioli, Gianluca; Fernandes E Fernandes, Jose; Fraedrich, Gustav; Geroulakos, George; Golledge, Jonathan; Gupta, Ajay; Gurevich, Victor S; Jawien, Arkadiusz; Jezovnik, Mateja K; Kakkos, Stavros K; Knoflach, Michael; Lanza, Gaetano; Liapis, Christos D; Loftus, Ian M; Mansilha, Armando; Nicolaides, Andrew N; Pini, Rodolfo; Poredos, Pavel; Proczka, Robert M; Ricco, Jean-Baptiste; Rundek, Tatjana; Saba, Luca; Schlachetzki, Felix; Silvestrini, Mauro; Spinelli, Francesco; Stilo, Francesco; Suri, Jasjit S; Svetlikov, Alexei V; Zeebregts, Clark J; Chaturvedi, Seemant; Veith, Frank J; Mikhailidis, Dimitri P     «

Paraskevas, Kosmas I; Gloviczki, Peter; Antignani, Pier Luigi; Comerota, Anthony J; Dardik, Alan; Davies, Alun H; Eckstein, Hans-Henning; Faggioli, Gianluca; Fernandes E Fernandes, Jose; Fraedrich, Gustav; Geroulakos, George; Golledge, Jonathan; Gupta, Ajay; Gurevich, Victor S; Jawien, Arkadiusz; Jezovnik, Mateja K; Kakkos, Stavros K; Knoflach, Michael; Lanza, Gaetano; Liapis, Christos D; Loftus, Ian M; Mansilha, Armando; Nicolaides, Andrew N; Pini, Rodolfo; Poredos, Pavel; Proczka, Robert M; Ri...     »

International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C with statins or non-statin medications for Asx/SCS patients. The cerebrovascular and CV beneficial effects associated with statins, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and other non-statin lipid-lowering agents (e.g. fibrates, ezetimibe) are reviewed. The use of statins and PCSK9 inhibitors is associated with several beneficial effects for Asx/SCS patients, including carotid plaque stabilization and reduction of stroke rates. Ezetimibe and fibrates are associated with smaller reductions in stroke rates. The side-effects resulting from statin and PCSK9 inhibitor use are also highlighted. The benefits associated with lowering LDL-C with statins or non-statin lipid lowering agents (e.g. PCSK9 inhibitors) outweigh the risks and potential side-effects. Irrespective of their LDL-C levels, all Asx/SCS patients should receive high-dose statin treatment±ezetimibe or PCSK9 inhibitors for reduction not only of LDL-C levels, but also of stroke, cardiovascular mortality and coronary event rates.      «

International guidelines strongly recommend statins alone or in combination with other lipid-lowering agents to lower low-density lipoprotein cholesterol (LDL-C) levels for patients with asymptomatic/symptomatic carotid stenosis (AsxCS/SCS). Lowering LDL-C levels is associated with significant reductions in transient ischemic attack, stroke, cardiovascular (CV) event and death rates. The aim of this multi-disciplinary overview is to summarize the benefits and risks associated with lowering LDL-C...     »