The prevalence of peripheral arterial disease is between 15% and 20% of patients older than 65 years and its severity is greatly underestimated. In fact, annual mortality is higher in patients with peripheral arterial disease (8.2%) than in those after acute myocardial infarction (6.3%). Despite the above, medical advice and efforts to modify risk factors are far below those observed in those with coronary heart disease or stroke.
Definitely we are doing something wrong…
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The guidelines for the indication of statins in peripheral vascular disease, are largely extrapolated from the data of coronary disease or stroke. Therefore, the objective of this study was to determine the effect of the intensity of statin treatment in this specific population over hard end points such as amputation and mortality.
An intensive treatment with statins was compared with a moderate/mild treatment and antiplatelet therapy, but without statins.
A cohort of 155,647 patients with peripheral vascular disease was included, of which more than a quarter (28%) were not receiving statins.
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The use of intensive treatment was only 6.4%, compared to 18.4% of those with a diagnosis of coronary or carotid disease.
The incidence of amputation and death, decreased significantly with any dose of statins versus antiplatelet therapy alone. But this reduction was also increasing as the intensity of the treatment increased (intensive treatment amputation HR 0.67, CI 95% 0.61 to 0.74 versus mild/moderate treatment; amputation HR 0.81 0.75 to 0.86 and intensive treatment mortality HR 0.74, CI 95% 0.70 to 0.77 versus mild/moderate mortality HR 0.83 0.81 to 0.86 with p<0.001 for all comparisons).
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The association between the intensity of statin treatment and the reduction of amputations and death, remained significant after adjustment with propensity score, sensitivity analysis and subgroup analysis.
Conclusion
Statins, particularly aggressive schemes, are underutilized in peripheral vascular disease. This is the first population study that shows that the intensity of statin treatment at the time of diagnosis of peripheral vascular disease is associated with a reduction in amputations and mortality.
Original title: Statins Have a Dose-Dependent Effect on Amputation and Survival in Peripheral Artery Disease Patients.Reference: Shipra Arya et al. Circulation. 2018 Jan 12. Epub ahead of print.
Reference: Shipra Arya et al. Circulation. 2018 Jan 12. Epub ahead of print.
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