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Home > Vascular Annual Meeting > PP6. Effectiveness of Pharmacologic Risk Modification...

PP6. Effectiveness of Pharmacologic Risk Modification in the Prevention of Symptom Development in Patients with Asymptomatic Carotid Artery Occlusive Disease

Panagiotis Kougias, Joanna Forbes, Tam T. Huynh, Carlos F. Bechara, Catherine Cagiannos, Peter H. Lin
Baylor College of Medicine, Houston, TX

OBJECTIVES: Patients with carotid artery occlusive disease (CAOD) are often not offered intervention under the notion that aggressive medical management might reduce their risk of stroke. This study was undertaken to investigate the effectiveness of multiagent treatment with antiplatelets, statins, beta blockers, and angiotensin converting enzyme inhibitors (ACE I) in the prevention of neurologic complications in patients with asymptomatic 60-79% internal carotid artery (ICA) stenosis.

METHODS: Using a case-control design the medical regimen of 176 patients with 60-79% ICA stenosis who developed symptoms of stroke or transient ischemic attack (TIA) was compared to that of 218 asymptomatic patients with similar ICA stenosis range . Odds ratio (OR) and 95% confidence intervals (CI) were calculated for each of the variables of interest, whereas level of significance was determined with Fisher’s exact test. A logistic regression equation that utilized interaction expansion variables was modeled to assess combined effects of individual medication classes on the development of neurologic symptoms.

RESULTS: Both groups were matched for age, gender, range of stenosis in the diseased carotid artery and the occurrence of hypertension, hyperlipidemia, diabetes, coronary artery disease, smoking, and chronic obstructive pulmonary disease. Cases were more likely to have a history of stroke than the controls (OR: 2.07, CI: 1.17-3.68, p=0.007). The odds of developing either stroke or TIA was not affected by the use of antiplatelets (OR: 1.4, CI: 0.85-1.93, p=0.09), statins (OR: 1.02, CI: 0.66-1.58, p=0.9), ACE I (OR: 0.82, CI: 0.54-1.25, p=0.34), or beta blockers (OR: 0.96, CI: 0.63-1.46, p=0.85). The lack of correlation persisted after adjustment for possible counfounding effect among the different medication classes. The interaction logistic regression model demonstrated that only the combination of antiplatelet with beta blockers decrease the odds for occurrence of symptoms (OR: 0.34, CI: 0.14-0.78, p=0.011).

CONCLUSIONS: Multiagent pharmacotherapy does not provide a definitive neurologic risk reduction in patients with moderate asymptomatic carotid stenosis. Larger prospective studies are necessary to address the role of pharmacotherapy in neurologic complication prevention among patients with CAOD.

AUTHOR DISCLOSURES: P. Kougias, None; J. Forbes, None; T.T. Huynh, None; C.F. Bechara, None; C. Cagiannos, None; P.H. Lin, None.