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Statins lowered risk for major adverse events, mortality, amputation in patients with CLI
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In patients with critical limb ischemia, the use of statins may decrease the risk for mortality and major adverse CV and cerebrovascular events and increase amputation-free survival, according to new data from the PAD-UCD registry.
Researchers conducted a retrospective evaluation of 380 patients who presented with critical limb ischemia (CLI). The PAD-UCD registry includes all patients diagnosed with peripheral artery disease who had diagnostic angiography and/or endovascular intervention at UC Davis Medical Center from 2006 to 2012.
Patients were placed into the statin group if recent medical records reflected current statin use, and other medication regimens were established based on the patient’s most recent preprocedure visit. Baseline serum LDL levels were established using the most recent value within 6 months prior to the procedure.
The study’s primary endpoint was a composite of major adverse CV and cerebrovascular events (MACCE), which included any death, MI or stroke within 1 year after the procedure. Secondary outcomes included death, MI, stroke, ensuing ipsilateral lower-extremity bypass grafting, and ipsilateral major amputation. To adjust for the competing risk for death among patients at high risk for amputation, the researchers also assessed amputation-free survival as a composite endpoint.
Results showed that LDL levels were lower among patients prescribed statins (75 ± 28 mg/dL vs. 96 ± 40 mg/dL; P<.001).
At baseline, the patients in the statin group presented with more comorbidities, including diabetes, CAD and hypertension, and more pervasive lower extremity disease (all P<.05). After propensity score weighting, statin use was found to correlate with lower 1-year incidence of MACCE (HR=0.53; 95% CI 0.28-0.88), mortality (HR=0.49; 95% CI 0.24-0.97), and major amputation or death (HR=0.53; 95% CI 0.35-0.98).
Among patients undergoing infrapopliteal angioplasty for lower extremity lesions, statin use improved patency in these lesions. In those with LDL levels >130 mg/dL, the risk for MACCE and death was higher compared with those with lower LDL levels.
“While our data on statin use rates compares quite favorably to previously published studies, statins remain an underutilized therapy,” the researchers wrote. “Our finding of superior outcomes in patients with lower LDL levels also provides support for the use of LDL as a treatment target in patients with PAD. Future studies should determine the optimal statin type and dose, further explore potential treatment targets, including LDL for statins in PAD patients, and investigate barriers to more widespread use of statins among patients with CLI.”
Disclosure: The researchers report no relevant financial disclosures.
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