Waimei Tai, MD

Heyer et. al. had a prospective observational study of 328 patients with asymptomatic stenosis who were observed to be on a statin or not on a statin. There were no statistical differences in the two cohorts (statin vs. no statin) although there appeared to be a trend of younger people in the statin arm (likely confounded as non-prescription of statins is higher in older patients for any reason). 

They also concluded that patients had better cognitive function if they had a statin prescription. Certainly it makes sense if those on a statin had a lower peri-operative stroke incidence (0.0% vs 3.1%) it makes sense that cognitive function for the cohort without strokes would be higher. 

It would be interesting to know the relationship between the patient’s cholesterol levels, cognitive function, and statin use as other studies have suggested a correlation between lower cholesterol levels and poorer cognitive function, although the pathophysiology maybe different (statins in periop phase maybe protective against stroke, naturally low cholesterol levels maybe correlated with other markers of neurodegenerative disease).

For the time being, I think I will continue statin prescription for my asymptomatic carotid patients, as I think it’s reasonable to treat large vessel carotid disease with optimal cholesterol lowering/plaque stabilizing medication. Whether they need to get carotid endarterectomy, now that’s another question. 

How do you treat your asymptomatic carotid patients?