Preoperative statin and diuretic use influence the presentation of patients undergoing carotid endarterectomy: Results of a large single-institution case-control study

Abstract

Patients who present for carotid endarterectomy (CEA) with symptoms of stroke or transient ischemic attack (TIA) have worse postoperative outcomes than patients with asymptomatic carotid disease. We undertook this study to see whether preoperative medication use or patient characteristics were associated with the presence of symptomatic cerebrovascular disease at the time of operation. A retrospective case-control study was performed among patients presenting for elective CEA at a single academic institution between 1994 and 2004. A total of 660 (42%) symptomatic patients were identified from an institutional database and compared with 901 (58%) control patients who were asymptomatic at the time of CEA. The independent association of cerebrovascular symptoms with patient variables was assessed by using multivariate logistic regression analysis after propensity score adjustment. The mean age and sex distribution were similar between cases and controls, although symptomatic patients were more likely to have an ulcerative plaque (18% symptomatic vs 11% asymptomatic; P < .01). Compared with asymptomatic controls, patients presenting for CEA with symptoms of stroke or TIA were less likely to have hyperlipidemia (43% vs 55%; P < .01) or a history of coronary artery disease (43% vs 54%; P < .01) and were less likely to be receiving statins (35% vs 47%; P < .01), beta-blockers (34% vs 44%; P < .01), and diuretics (22% vs 31%; P < .01). After controlling for potential interaction and confounding by using propensity score adjustment and logistic regression analysis, preoperative use of statins (adjusted odds ratio, 0.72; 95% confidence interval, 0.56-0.92; P = .01) and diuretics (adjusted odds ratio, 0.74; 95% confidence interval, 0.58-0.95; P = .02) were independently associated with a lower likelihood of having cerebrovascular symptoms at the time of CEA. We observed that patients receiving statins or diuretics were less likely to present for CEA with symptoms of stroke or TIA. These data raise the question of whether the preoperative use of these medications protects patients with carotid stenosis from developing symptomatic disease and contributes to improved outcomes among patients undergoing CEA. Further research is needed to assess the optimal medical management of patients before vascular surgery.