An influential group of doctors say there is growing evidence that certain drugs could be of benefit greater than or equal to surgery or stents in preventing stroke---with much reduced risk.
These drugs include statins--commonly associated with treating high cholesterol--as well as blood-pressure medications and anticlotting drugs such as aspirin. "I've commonly had people come in for a second opinion after surgery or a stent was recommended," says Frank J. Veith, a vascular surgeon at New York University Medical Center. "After I explain the risks from procedures and the possible benefits, almost all of them opt for statins."
At issue are strokes caused when clots or fatty plaque in the carotid arteries begin to impede blood flow to the brain. A glob of this debris can dislodge, float up into the brain and block any of several small arteries there. Brain-tissue death can begin quickly, leaving patients with a range of outcomes from mild impairment to paralysis or death. Doctors say carotid-artery blockage plays a role in as many as half the 780,000 strokes that occur in the U.S. each year. Other factors that cut oxygen flow to the brain account for the remainder.
It's possible to know how many patients are prescribed drugs to help prevent stroke. In recent years, evidence has been accumulating that drugs can play powerful roles in noninvasively keeping plaque from growing and there is some evidence drugs might also be able to reduce plaque. A 2006 study of the statin Lipitor in 1,007 patients at high risk for stroke and with carotid blockage found the group taking the drug had a 33% reduced risk of stroke compared with those on placebo.
"I'm a big believer in medical therapy," says Michael R. Jaff, a Harvard professor and medical director of the Massachusetts General Hospital's vascular center. However, he said: "It is well known that many patients who require drug therapy either don't get it, don't get treated to goal [to achieve target numbers for cholesterol and blood pressure] or are not compliant with their meds."
Source: The Wall Street Journal, March 3, 2009
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