**16. Renal artery stenosis hypertension and cholesterol**

disease are accompanied by coronary artery disease. Peripheral artery disease should be considered as equivalent to coronary artery disease risk. Deaths are mostly of cardiac origin.

According to the REACH study, 3-year vascular-induced deaths were more common in patients with peripheral arterial disease than in those with coronary and carotid artery disease [24]. The use of statin has reduced both symptoms and cardiovascular mortality in a

Ischemic stroke should be investigated in two groups as embolic and thrombotic stroke.

Smoking and age are the most important risk factors for carotid atherosclerosis. The atherosclerotic plaque is located in the bifurcation area and often extends on the outer wall of the

When stenotic plague increases, the risk of emboli increases. Carotid stenosis is defined as a stenosis of 50% or more in the extracranial portion of the internal carotid artery. In addition to the luminal narrowing, the lesion's edge irregularity, the presence of intraplate plaque hemorrhage, whether the lesion is unilateral or not, also determines the severity of the disease. Symptomatic carotid stenosis is the occurrence of symptoms related to carotid stenosis in the last 6 months. In the heart protection study with simvastatin, a reduction of 39 mg/dL at the LDL level resulted in a 20% reduction in major cardiovascular events, 25% reduction in stroke, and 38%

In the SPARCLE trial (stroke prevention by aggressive reduction in cholesterol levels), patients who had stroke and TIA within the last 1–6 months were evaluated for 5 years. In patients receiving high-dose atorvastatin, a reduction of 43% in LDL levels resulted in a 20% reduction in major cardiovascular events and a 16% reduction in stroke. Despite the increase in hemorrhagic stroke rates in the high-dose statin group, there was no difference in lethal

It has been suggested that statin therapy initiated after stroke also improves neurological function with a decrease in infarct area. According to the information obtained from the metaanalyses, the use of statin before and after stroke is associated with improvement in neurological function. However, there was a relationship between statin therapy and hemorrhagic

Carotid intima media thickness is a subclinical atherosclerosis indicator and it is recommended to use it in addition to classical cardiovascular risk indicators, especially in individuals with hypertensive middle cardiovascular risk (SCORE risk 1–5%). Values above 0.9 mm or values above normal 75th percentile should be considered pathological. According to the American Society of Echocardiography, these individuals should be considered as having increased CV risk. Individuals between 75 and 25% have expected cardiovascular risk. Individuals below

transformation in cases treated with thrombolytic therapy [29].

the 25th percentile have low cardiovascular risk [30].

variety of studies on peripheral arterial disease [25, 26].

**15. Carotid diseases, stroke, and cholesterol**

carotid bulb.

102 Cholesterol - Good, Bad and the Heart

reduction in ischemic stroke [11].

hemorrhagic stroke [27, 28].

Renovascular hypertension is about 5% of all hypertension cases. In the presence of peripheral artery disease, the frequency of renal artery stenosis reaches up to 14%. There is an increase in the frequency of renal artery stenosis and peripheral artery disease association in the presence of diffuse peripheral artery disease [31]. Atherosclerotic renal artery disease is the most common cause of renovascular hypertension. Atherosclerotic renal artery disease is often defined as having ≥60% stenosis in the osteal or proximal one-third of the renal artery. The second most common cause is fibromuscular dysplasia in younger individuals with no atherosclerotic risk factors. There is a "string of beats" view at the distal one-third of the renal artery. Renal artery stenosis can be tolerated by autoregulation mechanisms until the renal perfusion pressure reaches 70 mmHg. Renal revascularization has not been shown to reduce hypertension, renal, or cardiovascular events. Antihypertensive therapy, antiplatelet therapy, and statins are the main treatments.
