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High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management
Linköping University.
Linköping University.
Linköping University.
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
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2016 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 13, 1453-1460 p.Article in journal (Refereed) Published
Abstract [en]

Background Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Design Cross-sectional retrospective study. Methods Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). Results A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. Conclusions The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.

Place, publisher, year, edition, pages
2016. Vol. 23, no 13, 1453-1460 p.
Keyword [en]
atherosclerosis, cardiovascular disease, cardiovascular risk management, High-grade carotid stenosis, secondary prevention
National Category
Cardiac and Cardiovascular Systems Nursing Surgery
Research subject
Health and Caring Sciences, Nursing
Identifiers
URN: urn:nbn:se:lnu:diva-56078DOI: 10.1177/2047487316632629ISI: 000382655100013PubMedID: 26879568Scopus ID: 2-s2.0-84981543056OAI: oai:DiVA.org:lnu-56078DiVA: diva2:971356
Available from: 2016-09-16 Created: 2016-08-31 Last updated: 2016-10-04Bibliographically approved

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