Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry.
- Kumbhani DJ Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA dharam@post.harvard.edu.
- Steg PG Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK.
- Cannon CP Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA.
- Eagle KA University of Michigan Cardiovascular Center, Ann Arbor, MI, USA.
- Smith SC Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Goto S Department of Medicine, Tokai University School of Medicine, Isehara, Japan.
- Ohman EM Division of Cardiology, Duke University, Durham, NC, USA.
- Elbez Y Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.
- Sritara P Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
- Baumgartner I Swiss Cardiovascular Center Bern, University Hospital Bern, Switzerland.
- Banerjee S Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA.
- Creager MA Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
- Bhatt DL Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA.
- 2014-03-04
Published in:
- European heart journal. - 2014
Claudication
Morbidity
Peripheral vascular disease
Registry
Statins
Aged
Coronary Artery Disease
Disease Progression
Extremities
Female
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Intermittent Claudication
Ischemia
Male
Peripheral Arterial Disease
Physician's Role
Registries
Treatment Outcome
English
AIMS
Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry.
METHODS
Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users.
RESULTS
A total of 5861 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).
CONCLUSION
Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.
Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry.
METHODS
Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users.
RESULTS
A total of 5861 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).
CONCLUSION
Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1093/eurheartj/ehu080
- PMID 24585266
- Persistent URL
- https://folia.unifr.ch/global/documents/115271
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