Statin therapy initiation after index revascularization in patients with peripheral arterial occlusive disease was associated with significant reductions in mortality, cardiovascular (CV) events, and reduced risk for amputation in patients with chronic limb-threatening ischemia, according to a study published in the Journal of the American Heart Association.

A total of 22,208 patients (mean age, 71.1 years) with peripheral arterial occlusive disease were identified using health insurance claims data from BARMER, Germany’s second-largest insurance fund. Patients included in this study had index revascularization between 2008 and 2018, no history of statin therapy, and received ≥1 antithrombotic medication in the first quarter after discharge. After propensity matching, 2112 patients with chronic limb-threatening ischemia were included in each group: new statin users and nonusers. Patients were further classified as having intermittent claudication or chronic limb-threatening ischemia.

The study’s efficacy outcomes were all-cause mortality, CV events (myocardial infarction/stroke/transient ischemic stroke), and incident major amputation. Safety outcomes were incident diabetes mellitus and incident myopathy.


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In patients with chronic limb-threatening ischemia, statin initiation was associated with lower all-cause mortality (hazard ratio [HR], 0.75; 95% CI, 0.68–0.84), lower risk for major amputation (HR, 0.73; 95% CI, 0.58–0.93), and reduced risk for CV events (HR, 0.80; 95% CI, 0.70–0.92) during the 5-year follow-up. In patients with intermittent claudication, statin initiation was associated with a reduced risk for all-cause mortality (HR, 0.80; 95% CI, 0.70–0.92) and lower risk for CV events (HR, 0.80; 95% CI, 0.70–0.92).

Safety outcomes were comparable in patients with chronic limb-threatening ischemia and intermittent claudication.

Study limitations include its retrospective nature.

“[W]e found no evidence for the assumption that new patient groups benefit less from statins, emphasizing the importance of quality improvement and awareness campaigns to improve prescription rates,” noted the study authors.

Reference


Peters F, Kuchenbecker J, Kreutzburg T, Marschall U, Debus ES, Behrendt CA. Long-term effectiveness and safety of initiating statin therapy after index revascularization in patients with peripheral arterial occlusive disease. J Am Heart Assoc. 2020;9(22):e018338. doi:10.1161/JAHA.120.018338