Paraskevas Kosmas I, Veith Frank J, Eckstein Hans-Henning, Ricco Jean-Baptiste, Mikhailidis Dimitri P
Department of General and Vascular Surgery, Central Clinic of Athens, Athens, Greece.
Division of Vascular Surgery, New York University Langone Medical Center, NY, USA.
Ann Transl Med. 2020 Oct;8(19):1265. doi: 10.21037/atm.2020.02.176.
Hypercholesterolemia is a risk factor for carotid artery stenosis and stroke. Statins are the main drugs for the management of hypercholesterolemia and they are strongly recommended by international guidelines for the management of vascular patients. The present review will focus on the associations between cholesterol, carotid artery stenosis and stroke and will cover several topics, including the conservative and perioperative/periprocedural management of carotid patients, the effect of statins on contrast-induced nephropathy developing after endovascular carotid interventions, the role of statin loading prior to endovascular procedures, as well as the indirect beneficial effects of statin treatment on renal function. It will also discuss the topics of statin intolerance and alternative cholesterol-lowering options for statin-intolerant vascular patients. Cholesterol levels play a prognostic role in carotid patients with regards to both short- and long-term stroke and mortality rates. Physicians should keep in mind the pivotal role of cholesterol levels in determining cardiovascular outcomes and the pleiotropic beneficial effects associated with statin use and should not miss the opportunity for cardiovascular risk reduction with aggressive statin treatment.
高胆固醇血症是颈动脉狭窄和中风的危险因素。他汀类药物是治疗高胆固醇血症的主要药物，国际血管疾病患者管理指南强烈推荐使用。本综述将聚焦于胆固醇、颈动脉狭窄和中风之间的关联，并涵盖多个主题，包括颈动脉疾病患者的保守治疗以及围手术期/围操作期管理、他汀类药物对血管内颈动脉介入术后发生对比剂肾病的影响、血管内手术前他汀类药物负荷的作用，以及他汀类药物治疗对肾功能的间接有益作用。还将讨论他汀类药物不耐受的话题以及他汀类药物不耐受的血管疾病患者的替代降胆固醇选择。胆固醇水平在颈动脉疾病患者的短期和长期中风及死亡率方面具有预后作用。医生应牢记胆固醇水平在决定心血管结局中的关键作用以及与使用他汀类药物相关的多效性有益作用，不应错过通过积极的他汀类药物治疗降低心血管风险的机会。
