Abstract
BACKGROUND: The extent of atherosclerosis in healthy men and women was measured using ultrasound on the carotid artery, and it was investigated whether early treatment with statins in subjects with advanced atherosclerosis improves the outcome for cardiovascular disease and cancer. METHOD: From 2009 to 2017, 5,186 subjects (39.1% women) aged 35-65 with no signs of cardiovascular disease underwent ultrasound examination of the carotid artery. The total plaque area (TPA) and maximum plaque thickness were measured. RESULTS: A follow-up was available for 4,340 (83.7%) participants. The mean follow-up period was 87 months (7.3 years) for men and 79 months (6.6 years) for women. Advanced atherosclerosis (type III, IVb) was present in 506 (11.7%) subjects. Statin treatment was initiated in 186 (36.8%) of the subjects. Events (heart attack, ischemic stroke, coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA)) occurred in 170 (3.9%) of the 4,340 subjects with follow-up data. Cancer occurred in 71 (1.7%) of the subjects. The event rate for cardiovascular events was 37.6% in men with advanced atherosclerosis without statin therapy vs. 1.6% (P < 0.0001) in those with low-to-moderate plaque burden; for cancer, the rates were 8.6% vs. 1.2% (P < 0.0001). In women with advanced atherosclerosis, the event rate for cardiovascular events without statin therapy was 14.8% vs. 0.2% (P < 0.0001) in those with low-to-moderate plaque burden; and for cancer, the rates were 7.4% vs. 0.9% (P = 0.002). Treatment of male subjects with advanced atherosclerosis (type III, IVb) with a statin significantly improved the prognosis. The event rate for cardiovascular events was 16.1% in men in the treated group vs. 37.6% (P < 0.0001) in the untreated group, and 2.7% vs. 14.8% (P = 0.077) in women. The event rate for cancer was 2% in men in the treated group vs. 8.6% (P = 0.006) in the untreated group. Due to the low number of cases in women, a statistical evaluation did not make sense. Mortality (from any cause) was significantly lower in men treated with statins (P = 0.008). CONCLUSIONS: Treatment with statins in subjects with advanced atherosclerosis of the carotid artery (type III, IVb findings on ultrasound) significantly improved the prognosis in a non-randomized observational study.