Editors' ChoiceNeurology

Staying Smart on Statins

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Science Translational Medicine  01 May 2013:
Vol. 5, Issue 183, pp. 183ec72
DOI: 10.1126/scitranslmed.3006369

Over the past decade, medical management of asymptomatic carotid artery stenosis has advanced dramatically. Treatment efficacy has improved by combining antiplatelet agents, lipid-lowering therapies, and targeted lifestyle modifications. Recently, the indications for carotid endarterectomy (CEA) surgery in patients with high-grade asymptomatic stenosis have been called into question. Now, Heyer and colleagues offer a potential answer. They investigate whether preoperative statin treatment is associated with a lower incidence of neurological and cognitive injury after CEA.

The authors used detailed neuropsychometric testing to evaluate cognitive function. The assessment tool has been validated in prior studies. A total of 324 asymptomatic carotid stenosis patients underwent CEA surgery and completed the entire battery of tests. Pre- and postoperative results were compared and translated to z scores. The data revealed that patients taking statins had a lower incidence of clinical stroke (P = 0.02). In a multivariate regression model, statin use was significantly associated with decreased odds of cognitive dysfunction (odds ratio 0.51, 95% confidence interval 0.27 to 0.96, P = 0.04). The authors controlled for variables that had been previously determined to affect neurocognitive outcome.

In clinical practice, a gross neurological examination is typically used to determine the periprocedural efficacy of CEA surgery. As patient outcome metrics become increasingly important, so too do the assessment tools used to evaluate them. This study uses a detailed neuropsychometric battery of tests to reveal an association between statin use and improved neurocognitive outcome in a large cohort of asymptomatic CEA patients. The documented statin treatment effect might not have been demonstrated through traditional outcome measures. The results of this study raise two important questions. First, could statin administration decrease the incidence of neurocognitive decline after CEA in routine clinical practice? Second, are current clinical outcome assessments appropriate and sufficient to determine the indications and utility of CEA surgery?

E. J. Heyer et al., Statins reduce neurologic injury in asymptomatic carotid endarterectomy patients. Stroke 44, 1150–1152 (2013). [Full Text]

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