Conference Coverage

High-intensity statins cut amputations and mortality in PAD

 

Key clinical point: High-intensity statin therapy in patients with peripheral artery disease saves lives and limbs.

Major finding: The 5-year all-cause mortality rate after diagnosis of peripheral artery disease was 20.4% in patients on high-intensity statin therapy, 28.6% in those on a low- or moderate-intensity statin, and 33.9% in patients not on a statin.

Data source: A retrospective observational study of 208,194 patients with clinical peripheral artery disease in the national Veterans Affairs database for 2003-2014.

Disclosures: The AHA and the Atlanta Veterans Affairs Medical Center funded the study. The presenter reported having no financial conflicts of interest.


 

AT THE AHA SCIENTIFIC SESSIONS

– High-intensity statin therapy in patients with peripheral artery disease was associated with significant reductions in amputations as well as mortality during up to 5 years of follow-up in the first large study to examine the relationship, Shipra Arya, MD, reported at the American Heart Association scientific sessions.

Low- or moderate-intensity statin therapy also improved survival compared to no statin, albeit to a significantly lesser magnitude than high-intensity therapy. But high- and low/intermediate-intensity statins were similarly effective in reducing amputation risk, according to Dr. Arya, a vascular surgeon at Emory University in Atlanta.

Incidence of key outcomes by statin use in patients with PAD
She presented a retrospective observational study of 208,194 patients with clinical peripheral artery disease (PAD) in the national Veterans Affairs database for 2003-2014, of whom 98% were men. In her study, Dr. Arya examined the association between the highest statin dose prescribed within 1 year of PAD diagnosis and rates of amputation and all-cause mortality at 1, 3, and 5 years of follow-up. During this interval there were 17,643 amputations, of which 14,981 were considered major amputations, as well as 99,870 deaths.

The 2013 AHA/American College of Cardiology treatment guidelines recommend high-intensity statins for all patients with clinical atherosclerotic disease, including those with PAD (Circulation. 2014 Jun 24;129[25 Suppl 2]:S1-45). (Updated PAD guidelines unveiled at the AHA meeting strongly recommend statin medication for all patients with PAD [Circulation. 2016 Nov 13. doi: 10.1161/CIR.0000000000000470]).However, the bulk of patients in Dr. Arya’s study were captured in the database prior to release of the 2013 guidelines. That may account for the sparse use of high-intensity statin therapy in the study cohort. Indeed, only 11.3% of the PAD patients were on a high-intensity statin. Another 36.2% were on moderate-intensity statin therapy, 3.5% were on low-intensity therapy, and 27.6% weren’t on a statin at all.

The relationship between statin therapy and mortality was strongly dose-dependent.

This study was funded by the AHA and the Atlanta Veterans Affairs Medical Center. Dr. Arya reported having no financial conflicts of interest.

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