REACH: Statin Therapy Associated With Lower Rate of Adverse Limb Outcomes in PAD Patients

“What was interesting and incremental in this analysis was an associated reduction in the rate of peripheral ischemic events,” said Deepak Bhatt, MD, FACC.

Statin therapy in patients with peripheral artery disease (PAD) is associated with a significantly lower rate of adverse limb outcomes in addition to cardiovascular events, according to results from the REACH registry study presented at the ESC Congress 2013 on Sept. 3.

The study evaluated four-year data on both systemic and adverse limb outcomes in 5,861 patients with established symptomatic PAD enrolled in the international Reduction of Atherothrombosis for Continued Health (REACH) Registry. The primary adverse limb outcomes were worsening claudication or a new episode of critical limb ischemia, new lower extremity percutaneous or surgical revascularization, or new ischemic amputation. The primary systemic outcomes were cardiovascular death, nonfatal MI and nonfatal stroke.

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A total of 3,643 patients received statin therapy over four years, while 2,218 patients were not on statins for four years. Unadjusted Kaplan-Meier rates show that among the statin-treated patients, 22.0 percent had adverse limb outcomes versus 26.2 percent among the statin non-users; 14.7 percent had worsening claudication or a new episode of critical limb ischemia versus 18.2 percent of the non-users; 18.2 percent had new lower extremity percutaneous or surgical revascularization versus 21.7 percent of the non-users; and 3.8 percent had new ischemic amputation versus 5.6 percent of the non-users.

At four years, 19.6 percent of the statin users had systemic cardiovascular outcomes versus 20.3 percent of the statin non-users: 17.3 percent suffered all-cause mortality versus 19.7 percent of the non-users; 11.4 percent had cardiovascular mortality versus 12.4 percent of the non-users; 5.0 percent had nonfatal MI versus 4.6 percent of the non-users; and 6.0 percent had non-fatal stroke versus 6.8 percent of the non-users.

"Although prior studies have documented improvements in walking distance and coronary revascularization in patients with PAD, this is one of the first and largest studies to suggest an impact of adverse limb outcomes. The lower rate of ischemic amputations with statin use is an especially intriguing finding," said the study's presenter, Dharam Kumbhani, MD, assistant professor of internal medicine in the cardiology division at the University of Texas Southwestern Medical Center, Dallas.

Although statins have a class 1 indication for use in PAD patients, less than two-thirds of eligible patients with PAD receive statin therapy, according to data from a large international registry, Dr. Kumbhani noted. "Future research should focus on identifying barriers to improving patient and physician compliance with statin use across the entire spectrum of patients with PAD," he said.

Keywords: Registries, Stroke, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Peripheral Arterial Disease, Lower Extremity

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