Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease

Insights from the REACH registry

Dharam J. Kumbhani, Gabriel Steg, Christopher P. Cannon, Kim A. Eagle, Sidney C. Smith, Shinya Goto, E. Magnus Ohman, Yedid Elbez, Piyamitr Sritara, Iris Baumgartner, Subhash Banerjee, Mark A. Creager, Deepak L. Bhatt

Research output: Contribution to journalArticle

112 Citations (Scopus)

Abstract

Aims Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry. Methods Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users. Results A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01). Conclusion Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.

Original languageEnglish (US)
Pages (from-to)2864-2872
Number of pages9
JournalEuropean Heart Journal
Volume35
Issue number41
DOIs
StatePublished - Nov 1 2014

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Peripheral Arterial Disease
Registries
Extremities
Therapeutics
Amputation
Stroke
Myocardial Infarction
Confidence Intervals
Ischemia
Guidelines

Keywords

  • Claudication
  • Morbidity
  • Peripheral vascular disease
  • Registry
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease : Insights from the REACH registry. / Kumbhani, Dharam J.; Steg, Gabriel; Cannon, Christopher P.; Eagle, Kim A.; Smith, Sidney C.; Goto, Shinya; Magnus Ohman, E.; Elbez, Yedid; Sritara, Piyamitr; Baumgartner, Iris; Banerjee, Subhash; Creager, Mark A.; Bhatt, Deepak L.

In: European Heart Journal, Vol. 35, No. 41, 01.11.2014, p. 2864-2872.

Research output: Contribution to journalArticle

Kumbhani, DJ, Steg, G, Cannon, CP, Eagle, KA, Smith, SC, Goto, S, Magnus Ohman, E, Elbez, Y, Sritara, P, Baumgartner, I, Banerjee, S, Creager, MA & Bhatt, DL 2014, 'Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: Insights from the REACH registry', European Heart Journal, vol. 35, no. 41, pp. 2864-2872. https://doi.org/10.1093/eurheartj/ehu080
Kumbhani, Dharam J. ; Steg, Gabriel ; Cannon, Christopher P. ; Eagle, Kim A. ; Smith, Sidney C. ; Goto, Shinya ; Magnus Ohman, E. ; Elbez, Yedid ; Sritara, Piyamitr ; Baumgartner, Iris ; Banerjee, Subhash ; Creager, Mark A. ; Bhatt, Deepak L. / Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease : Insights from the REACH registry. In: European Heart Journal. 2014 ; Vol. 35, No. 41. pp. 2864-2872.
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abstract = "Aims Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry. Methods Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users. Results A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2{\%}. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2{\%}; hazard ratio (HR), 0.82; 95{\%} confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95{\%} CI, 0.73-0.96; P = 0.01). Conclusion Among patients with PAD in the REACH registry, statin use was associated with an ∼18{\%} lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.",
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AU - Eagle, Kim A.

AU - Smith, Sidney C.

AU - Goto, Shinya

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AB - Aims Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry. Methods Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users. Results A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01). Conclusion Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.

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