Statin Use in Peripheral Artery Disease Low Despite High Risk for ASCVD Events

Patients with peripheral artery disease (PAD) were found to have lower statin use compared with patients with coronary heart disease (CHD) or cerebrovascular conditions, despite a high risk for atherosclerotic cardiovascular disease (ASCVD) events according to study results published in Journal of the American College of Cardiology.

Prior studies suggest that patients with PAD vs other vascular disease are at increased risk for ASCVD events but may not receive the same level of statin therapy. In a retrospective analysis of data from the MarketScan and Medicare databases in the United States, researchers aimed to compare the risk for ASCVD events and statin use in patients with PAD, CHD, and cerebrovascular disease.

The primary ASCVD outcome of interest was a composite of CHD, cerebrovascular disease, and PAD events. Each component was investigated separately as secondary outcomes. All-cause mortality in Medicare patients was another a secondary outcome.

A total of 943,232 patients were included in the analysis (n=47,889 with PAD only; n=50,214 with PAD and CHD; n=13,609 with PAD and cerebrovascular disease; and n=44,407 with all 3 vascular conditions).

Over a median follow-up of 3 years, 83,738 ASCVD events occurred. The risk for ASCVD events was higher in patients with 2 vs 1 vascular conditions (hazard ratio [HR], 1.45; 95% CI, 1.42-1.48) and in patients with 3 vs 1 vascular conditions (HR, 2.08; 95% CI, 2.03-2.14). A similar trend was observed for all individual ASCVD events, with the higher risk difference observed for PAD events in patients with 3 vs 1 vascular conditions (HR, 3.91; 95% CI, 3.58-4.28).

The rate of ASCVD events was highest in patients with CHD among patients with 1 vascular condition. Patients with cerebrovascular disease vs CHD were at increased risk for ASCVD events after multivariate adjustment (HR, 1.08; 95% CI, 1.04-1.12). Patients with PAD vs CHD were at lower risk for ASCVD events (HR, 0.91; 95% CI, 0.86-0.95).

Among patients with 1 vascular condition, those with PAD only were at the highest risk for all-cause mortality. Patients with PAD were at 28% higher risk for all-cause mortality compared with patients with CHD.

Among patients with 2 vascular conditions, the rate of ASCVD events was highest in those with PAD and CHD, but there was no significant difference in the risk for ASCVD events between groups after adjustment. The risk for all-cause mortality was increased in patients with vs without PAD and either CHD (HR, 1.09; 95% CI, 1.06-1.12) or cerebrovascular disease (HR, 1.22; 95%. CI, 1.16-1.27).

Approximately half of patients with CHD used statin medication, whether they had CHD alone or in combination with other vascular conditions. Statin use was lower among patients without CHD. Patients with PAD only vs CHD only were found to be 25% less likely to use statins after multivariable adjustment.

“PAD, CHD, and cerebrovascular disease conferred a similar risk for ASCVD events. Despite their high risk for ASCVD events, patients with PAD are less likely to be taking a statin,” the study authors noted. “Results from the current study support the need for intensive ASCVD risk-reduction interventions including statin therapy among patients with a history of PAD.”

Disclosures: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Colantonio LD, Hubbard D, Monda KL, et al. Atherosclerotic risk and statin use among patients with peripheral artery disease. J Am Coll Cardiol. 2020;76(3):251-264. doi:10.1016/j.jacc.2020.05.048