Conference Coverage

High-intensity statins cut amputations and mortality in PAD



– 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.

Recommended Reading

The fast-changing world of lower-limb atherectomy
MDedge Cardiology
Decision rule identifies unprovoked VTE patients who can halt anticoagulation
MDedge Cardiology
Ticagrelor not superior to clopidogrel in peripheral artery disease
MDedge Cardiology
Bone marrow cells prove limb-saving for some
MDedge Cardiology
Ischemia-repairing cells fall short for treating intermittent claudication
MDedge Cardiology