How to reach optimal cardiovascular risk profile in carotid artery stenosis.

Carotid artery stenosis carries not only risk for ischemic strokes but also for other fatal cardiovascular events. Therefore, the control of modifiable cardiovascular risk factors as smoking, dyslipidemia, hypertension and diabetes mellitus is of primary importance in patients with carotid stenosis irrespectively of symptoms. This strategy is based on combination of lifestyle measures with pharmacotherapy. The basic lifestyle rule is expressed by the numbers 0-5-30; which mean 0 cigarettes, 5 portions of vegetables and fruits per day and 30 minutes of exercise per day. Very low concentrations of atherogenic LDL cholesterol (in patients at the highest risk less than 1.4 mmol/L) are to be reached; it is recently achievable by wide spectrum of potent hypolipemic drugs. In hypertension, the optimal levels of systolic blood pressure are 130-140 mmHg; in severe bilateral carotid stenoses slower lowering of blood pressure is recommended. Similarly, in diabetic individuals, hypoglycemia should be avoided caused by too intensive anti-diabetic treatment. Nevertheless, recently available antidiabetic drugs are less dangerous in this respect. Other risk factors recently under scrutiny are lipoprotein(a) and subclinical inflammation. Finally, very frequent but often critical and neglected risk factor is nonadherence of patients to cardiovascular risk management.