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

May 23, 2022Progress in cardiovascular diseases

Advantages and disadvantages of statin and non-statin cholesterol-lowering drugs in carotid artery disease

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Abstract

Lowering low-density lipoprotein cholesterol (LDL-C) levels is associated with significant reductions in stroke rates for patients with asymptomatic or symptomatic carotid stenosis.

Statins and PCSK9 inhibitors may stabilize carotid plaque and reduce stroke rates in patients with carotid stenosis.
Ezetimibe and fibrates are linked to smaller reductions in stroke rates compared to statins and PCSK9 inhibitors.
The benefits of lowering LDL-C levels with statins or non-statin agents appear to outweigh the associated risks and side effects.
All asymptomatic and symptomatic carotid stenosis patients should receive high-dose statin treatment along with possible ezetimibe or PCSK9 inhibitors.

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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.

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

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