Issue: August 2017
May 23, 2017
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Adherence to lipid-management guidelines benefits patients with CLI

Issue: August 2017
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Patients undergoing revascularization for critical limb ischemia had better mortality and major adverse limb event outcomes if they adhered to the statin intensity recommended in the 2013 American College of Cardiology/American Heart Association lipid-management guidelines, researchers reported.

The researchers conducted a retrospective analysis of all patients who underwent first-time endovascular or surgical revascularization for CLI — also called chronic limb-threatening ischemia — at Beth Israel Deaconess Medical Center, Boston, between 2005 and 2014.

After exclusion of patients on hemodialysis, 931 patients with 1,019 affected limbs were included and were stratified by intensity of statin therapy: high, moderate, low or none. According to the study background, the 2013 ACC/AHA guidelines recommend high-intensity statins for patients with CLI aged 75 years or younger and moderate-intensity statins for patients with CLI older than 75 years.

The researchers calculated propensity scores for probability of receiving guideline-recommended intensity of statin therapy. The primary outcomes were death and major adverse limb events. Median follow-up was 380 days.

Compared with those who were not, patients discharged on guideline-recommended statin therapy had higher rates of statin use before their procedure, CAD, chronic kidney disease, stroke, atrial fibrillation, congestive HF and prior CABG, Thomas F.X. O’Donnell, MD, from the division of vascular and endovascular surgery at Beth Israel Deaconess Medical Center, and colleagues wrote.

The recommended statin dose was taken in 35% of patients: 55% of those older than 75 years and 20% of those aged 75 years or younger, according to the researchers.

Discharge on any statin was associated with lower risk for mortality (HR = 0.71; 95% CI, 0.6-0.9), whereas discharge on the recommended intensity of statin therapy was associated with lower risk for mortality (HR = 0.73; 95% CI, 0.6-0.99) and major adverse limb events (HR = 0.71; 95% CI, 0.51-0.97), and the benefit did not differ by age, O’Donnell and colleagues wrote.

In patients older than 75 years, moderate-intensity statin therapy was associated with lower rates of death and major adverse limb events vs. high-intensity statin therapy, but the difference was not statistically significant (HR for death = 0.79; 95% CI, 0.49-1.26; HR for major adverse limb events = 0.82; 95% CI, 0.41-1.64), according to the researchers.

“Although adherence is improving, 60% of eligible patients in our institution were not receiving recommended [statin] doses even in 2014, an appealing target for future quality improvement projects,” O’Donnell and colleagues wrote. – by Erik Swain

Disclosure : The researchers report no relevant financial disclosures.