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Atherosclerotic Risk and Statin Use Among PAD Patients
Quick Takes
- Patients with peripheral artery disease (PAD) are at high risk for atherosclerotic cardiovascular disease (ASCVD) events.
- Statin therapy is significantly underutilized for patients with atherosclerotic disease, especially PAD.
- Increased used of statin therapy for patients with PAD and other atherosclerotic diseases may dramatically reduce future ASCVD events.
Study Questions:
What is the risk for atherosclerotic cardiovascular disease (ASCVD) events and the use of statin medications among patients with peripheral artery disease (PAD) as compared to those with coronary artery disease (CAD) or cerebrovascular disease?
Methods:
The authors conducted a retrospective cohort study of patients aged ≥19 years with commercial (MarketScan) or Medicare health insurance who had PAD, CAD, or cerebrovascular disease on December 31, 2014. They were followed for ASCVD events through December 31, 2017. Analyses were conducted using claims data. ASCVD events were defined as hospitalizations for myocardial infarction or coronary revascularization (CAD); stroke or carotid revascularization (cerebrovascular disease); and acute limb ischemia, peripheral artery revascularization, or nontraumatic amputation above the ankle (PAD). Statin use was assessed at the end of 2014.
Results:
Among 943,232 patients in the analytic cohort, the age-standardized ASCVD event rate per 1,000 patient-years was 34.7 (95% confidence interval [CI], 33.2-36.2) for patients with PAD only, 42.2 (95% CI, 41.5-42.8) for those with CAD only, and 38.9 (95% CI, 37.6-40.1) for those with cerebrovascular disease only. Patients with two or three concurrent conditions (PAD, CAD, cerebrovascular disease) experienced age-standardized ASCVD event rates per 1,000 patient-years of 68.9 (95% CI, 67.9-70.0) and 1,119.5 (95% CI, 117.0-122.0), respectively. Statin use was lowest among patients with PAD only (33.9%) as compared to those with cerebrovascular disease only (43.0%) or CAD only (51.7%).
Conclusions:
The authors concluded that despite having high risk for ASCVD events, patients with PAD are less likely to be taking a statin than patients with CAD or cerebrovascular disease.
Perspective:
This robust analysis confirms three key findings from prior cohort studies. First, all patients with atherosclerosis are at risk for future ASCVD events, no matter which arterial bed (cerebrovascular, coronary, peripheral) is impacted. Second, use of statin therapy, which can dramatically reduce ASCVD risk, is uniformly underprescribed. Third, patients with PAD are at high ASCVD risk yet have the lowest rate of statin use, especially high-intensity statin use. While the overall use of lipid-lowering therapies is likely to be greater in 2017 (or even in 2020), there is still much room for improvement. American College of Cardiology/American Heart Association guidelines strongly recommend statin therapy for all patients with PAD. Efforts to improve the implementation of this evidence-based therapy are critical for preventing future ASCVD events.
Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Cardiac Surgery and Arrhythmias, Lipid Metabolism, Nonstatins, Novel Agents, Statins, Interventions and Coronary Artery Disease, Interventions and Vascular Medicine
Keywords: Amputation, Atherosclerosis, Cardiovascular Diseases, Coronary Artery Disease, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Lipids, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Peripheral Arterial Disease, Primary Prevention, Stroke, Vascular Diseases
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