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(Stroke. 2006;37:2880.)
© 2006 American Heart Association, Inc.

Original Contributions

Impact of Carotid Endarterectomy on Medical Secondary Prevention After a Stroke or a Transient Ischemic Attack

Results from the Reduction of Atherothrombosis for Continued Health (REACH) Registry

Emmanuel Touzé, MD; Jean-Louis Mas, MD; Joachim Röther, MD; Shinya Goto, MD; Alan T. Hirsch, MD; Yasuo Ikeda, MD; Chiau-Suong Liau, MD, PhD; E. Magnus Ohman, MD; Alain J. Richard, MD, PhD; Peter W. F. Wilson, MD; P. Gabriel Steg, MD; Deepak L. Bhatt, MD for the REACH Registry Investigators

From Faculté de Médecine René Descartes, Université Paris 5, EA 4055, Department of Neurology (E.T., J.-L.M.), Hôpital Sainte-Anne, Paris, France; Department of Neurology (J.R.), Klinikum Minden, Hannover Medical School, Minden, Germany; Department of Medicine (S.G.), Tokai University School of Medicine, Kanagawa, Japan (Pr Goto); Minneapolis Heart Institute Foundation and Division of Epidemiology and Community Health (A.T.H.), University of Minnesota School of Public Health, Minneapolis, Minn; Division of Hematology (Y.I.), Keio University School of Medicine, Tokyo, Japan; Department of Internal Medicine (C.-S.L.), National Taiwan University Hospital and School of Medicine, Taipei, Taiwan; Division of Cardiology (E.M.O.), Duke University, Durham, NC; Global Medical Affairs–Clinical Operations (A.J.R.), Sanofi-Aventis, Paris, France; General Clinical Research Center (P.W.F.W.), Medical University of South Carolina, Charleston; Department of Cardiology (P.G.S.), Hôpital Bichat-Claude Bernard, Paris, France; Department of Cardiovascular Medicine (D.L.B.), Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to Jean-Louis Mas, Department of Neurology, Hôpital Sainte-Anne, 1 rue Cabanis 75674 Paris Cedex 14. E-mail jl.mas{at}ch-sainte-anne.fr

Background and Purpose— Whether a history of carotid endarterectomy influences patient compliance with medical treatments and physician attitude toward treatments after ischemic stroke or transient ischemic attack (TIA) is not well known.

Methods— We studied the baseline data of 18 467 ischemic stroke and TIA patients from the international REduction of Atherothrombosis for Continued Health (REACH) Registry and investigated the impact of a history of endarterectomy on the secondary medical prevention measured by the use of antiplatelet agents and statins, and by the control of cholesterol level, glucose level, and blood pressure.

Results— Among the patients with a history of ischemic stroke or TIA, those with a history of endarterectomy (n=1474) were more likely to receive antiplatelet agents and statins, to have a blood pressure <140/90 mm Hg, and a fasting total cholesterol <200 mg/dL. In diabetic patients, endarterectomy was associated with lower fasting blood glucose levels. In multivariate logistic regression analyses, endarterectomy was significantly associated with the use of antiplatelet agents (odds ratio [OR], 1.6; 95% CI, 1.3 to 1.9; P<0.0001) and statins (OR, 1.8; 1.6 to 2.0; P<0.0001), and with a cholesterol level <200 mg/dL (OR, 1.3; 1.2 to 1.5; P<0.0001). By contrast, the associations with blood pressure and blood glucose levels were no longer significant. There was no heterogeneity across the world regions or among the specialists who enrolled the patients.

Conclusions— Carotid endarterectomy is associated with a higher use of antiplatelet agents and statins in stroke/TIA patients. The absence of such an association with blood pressure and blood glucose control suggests that the individual determinants of the quality of the secondary medical prevention vary from one risk factor to another and from one class of drugs to another.

Key Words: antithrombotic agents • carotid endarterectomy • guidelines • prevention • risk factors • statins • stroke

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