Statin therapy and carotid endarterectomy: a review of trends in New South Wales, 1990-2004

• Published in: ANZ journal of surgery Vol. 79; no. 6; pp. 456 - 461
• Main Authors: Robinson, David A., Ghaly, Benjamin, Hayen, Andrew, Lusby, Robert J.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01-06-2009; Blackwell Publishing Ltd
• Subjects: Aged; Aged, 80 and over; Carotid Artery Diseases - drug therapy; Carotid Artery Diseases - mortality; Carotid Artery Diseases - prevention & control; carotid endarterectomy; Confidence Intervals; Drug Prescriptions - statistics & numerical data; Drug therapy; Drug Utilization; Endarterectomy, Carotid - methods; Endarterectomy, Carotid - trends; epidemiology; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Length of Stay; Male; Middle Aged; New South Wales - epidemiology; Regression Analysis; statin; Statins; Treatment Outcome; Trends; Vascular surgery; New South Wales; New South Wales Australia
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/j.1445-2197.2008.04795.x

Background:  The number of patients requiring carotid endarterectomy in our hospitals had been noted to be declining. Hence, our aim was to look at the numbers of carotid interventions in our State to see whether this trend was more pervasive and to look at trends in statin prescriptions over the same time‐course.
Methods:  We queried the New South Wales Department of Health Inpatients Statistics Collection database to determine the number of carotid interventions between 1 July 1990 and 30 June 2004. We also collected data on statin prescriptions from the Health Insurance Commission of the Australian Department of Health and Ageing. The trends in carotid interventions were examined using negative binomial regression.
Results:  The rate of carotid interventions increased by 9.8% between 1990 and 1991 and 1997 and 1998 and then declined from 1998 to 1999 through 2003 to 2004 by 6.8%. We noted a similar trend in octogenarians, although the peak was somewhat earlier. The prescription of statins was found to have increased eightfold between 1992 and 2003.
Conclusion:  The rate of carotid intervention has declined significantly from a peak in the late 1990s. This peak was at least partly accounted for by North American Symptomatic Carotid Endarterectomy Trial and Advances in Computer Sciences and Technology, studies that were conducted largely before the advent of statins. The number of persons in the community on statins has increased enormously since that time. We ponder over the influence of statins on the natural history of carotid artery disease and the implication this has for future trials of carotid intervention in asymptomatic patients.