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

Prog Cardiovasc Dis. 2022 Jul-Aug:73:41-47. doi: 10.1016/j.pcad.2022.05.003. Epub 2022 May 20.

Abstract

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.

Keywords: Best medical treatment; Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy; Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors; Statins.

Publication types

  • Review

MeSH terms

  • Anticholesteremic Agents* / adverse effects
  • Cardiovascular Diseases* / diagnosis
  • Cardiovascular Diseases* / drug therapy
  • Cardiovascular Diseases* / prevention & control
  • Carotid Artery Diseases* / diagnostic imaging
  • Carotid Artery Diseases* / drug therapy
  • Cholesterol, LDL
  • Ezetimibe / adverse effects
  • Fibric Acids
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects
  • Hypolipidemic Agents / adverse effects
  • Proprotein Convertase 9
  • Stroke*

Substances

  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Fibric Acids
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • PCSK9 protein, human
  • Proprotein Convertase 9
  • Ezetimibe