Published Online
on October 26, 2006

A more recent version of this article appeared on December 1, 2006

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Submitted on May 28, 2006
Revised on July 12, 2006
Accepted on August 17, 2006

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.

^* To whom correspondence should be addressed. 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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