Abstract Body: Introduction: Elevated Low-Density-Lipoprotein Cholesterol (LDL-C) blood levels are a risk factor for atherosclerosis. Lipid-lowering therapies mitigate the risk of atherothrombotic events. Among patients with atherosclerotic carotid stenosis, we aimed to compare asymptomatic to acute symptomatic patients in terms of LDL-C levels and lipid-lowering therapies.
Methods: Analysis of the ongoing prospective multicenter AtheroGEnic LipoprotEinS in Ischemic Stroke study (AGELESS; NCT05090878) investigating the influence of atherogenic lipoproteins on the risk of first-ever stroke in patients with asymptomatic and acute symptomatic atherosclerotic carotid stenosis, NASCET degree 30%-99%. For this study, acute symptomatic was defined as hemispheric ischemic stroke or retinal ischemia ipsilateral to the carotid stenosis, with symptom onset within 24 hours of admission. High-intensity lipid-lowering therapy was defined as high-potency statin (atorvastatin ≥40mg/d or rosuvastatin ≥20mg/d) or any combination of ≥2 lipid-lowering therapies.
Results: We included 296 patients with atherosclerotic carotid stenosis – median age 77 years (interquartile range [IQR] 70-82) – of which 59.8% were asymptomatic and 40.2% acute symptomatic. At enrolment, high-intensity lipid-lowering therapy was reported among 63.8% of patients with asymptomatic and 37.8% among acute symptomatic ones, p<0.001. Median LDL-C levels were 63 mg/dl (IQR 49-85 mg/dl) in asymptomatic and 101 mg/dl (IQR 73-134) in acute symptomatic patients, p<0.001. After adjusting for confounders including diabetes and coronary heart disease, high-intensity lipid-lowering therapy was not associated with symptomatic carotid stenosis, but LDL-C was: for every LDL-C increase by 39 mg/dl, the odds for a patient with carotid stenosis to be classified as symptomatic were 2.49 higher (95%CI of OR 1.82–3.42).
Conclusions: Among patients with atherosclerotic carotid stenosis of 30-99%, both lower proportions of high-intensity lipid-lowering therapy and higher LDL-C levels were associated with acute symptomatic carotid stenosis. After adjusting for confounders, only LDL-C levels were associated with the acute symptomatic status of carotid stenosis. Although causation cannot be established due to the cohort study design, the findings suggest that having or maintaining low LDL-C levels might prevent atherosclerotic carotid stenosis from becoming symptomatic.