Statin Therapy and Long-Term Adverse Limb Outcomes in Peripheral Artery Disease | Journal Scan

Study Questions:

What is the impact of statin use on limb prognosis in patients with symptomatic peripheral artery disease (PAD) enrolled in the international REACH registry?

Methods:

Statin use was assessed at study enrollment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users versus non-users.

Results:

A total of 5,861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins (22.0 vs. 26.2%; hazard ratio [HR], 0.82; 95% confidence interval [CI], 0.72-0.92; p = 0.0013). Results were similar when statin use was considered as a time-dependent variable (p = 0.018) and on propensity analysis (p < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; p = 0.01).

Conclusions:

The authors concluded that statin therapy not only reduces the risk of adverse cardiovascular events, but also favorably affects limb prognosis in patients with PAD.

Perspective:

This analysis of a large international cohort of patients with established PAD indicates that the use of statins remains less than optimal, especially in patients without coexisting coronary artery disease. Patients who were taking statins had a significantly lower risk of adverse limb and systemic cardiovascular outcomes at 4 years. It is important to identify barriers to patient and physician compliance with statin use across the entire spectrum of vascular diseases. Future research should assess a possible dose–response relationship between statin use and limb outcomes, and whether different low-density lipoprotein cholesterol targets may be necessary to prevent progressive PAD versus progressive cardiovascular outcomes in patients.

Clinical Topics: Dyslipidemia, Vascular Medicine, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Peripheral Arterial Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Amputation, Cholesterol, LDL, Coronary Artery Disease, Prognosis, Risk, Stroke, Mortality, Myocardial Infarction, Registries


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