Περίληψη:
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. © 2022 Elsevier Inc.
Συγγραφείς:
Paraskevas, K.I.
Gloviczki, P.
Antignani, P.L.
Comerota, A.J.
Dardik, A.
Davies, A.H.
Eckstein, H.-H.
Faggioli, G.
Fernandes e Fernandes, J.
Fraedrich, G.
Geroulakos, G.
Golledge, J.
Gupta, A.
Gurevich, V.S.
Jawien, A.
Jezovnik, M.K.
Kakkos, S.K.
Knoflach, M.
Lanza, G.
Liapis, C.D.
Loftus, I.M.
Mansilha, A.
Nicolaides, A.N.
Pini, R.
Poredos, P.
Proczka, R.M.
Ricco, J.-B.
Rundek, T.
Saba, L.
Schlachetzki, F.
Silvestrini, M.
Spinelli, F.
Stilo, F.
Suri, J.S.
Svetlikov, A.V.
Zeebregts, C.J.
Chaturvedi, S.
Veith, F.J.
Mikhailidis, D.P.
