Abstract Our prev ious work demonstrates that asymptomatic carotid endarterectomy (CEA ) patients demonstrate less perioperative neurologic in jury, defined as stroke and early cognitive dysfunction (eCD) observed within 24h r of CEA, when taking statins pre-operatively. This study examines whether the incidence of eCD observed 24hr after asympto matic CEA varies as a function of statin type or dose. Patients with asymptomatic carotid stenosis scheduled for CEA consented to participate in an observational IRB-approved study (N=324). Pat ients were evaluated with an extensive battery of neuropsychometric tests pre-operatively and 24hr post-operatively. Of the 324 consented patients, 200 were taking statins. Patients taking pravastatin and fluvastatin exhib ited no eCD, while patients taking lovastatin (17.7%) and rosuvastatin (16.7%) exh ib ited incidences of eCD similar to those not taking statins (20.2%). Patients taking simvastatin exhib ited a significantly lower incidence of eCD than those taking atorvastatin (3.0% vs. 16.0%, P=0.005). Patients taking a maximal dose of any statin exhib ited a significantly lower incidence of eCD than patients taking sub-maximal doses (2.7% vs. 15.9%, P=0.002). These observations suggest that the incidence of eCD may in fact vary as a function of statin type and that maximal doses may be the optimal dose for patients undergoing CEA. This variation may be due to the physico-chemical properties of statins such as lipophilicity, molecu lar size, and b lood brain barrier penetrability. These findings should be used to inspire randomized prospective work to determine the safety, feasibility, and outcomes of optimizing statin use prior to CEA
