AMSTERDAM – Treatment with a statin cut the relative rate of worsening peripheral artery disease by roughly 20% in a registry with nearly 6,000 peripheral artery disease patients.
But the registry data also showed that more than a third of patients with peripheral artery disease (PAD) failed to receive statin treatment, Dr. Dharam Kumbhani said at the annual Congress of the European Society of Cardiology.
"This is one of the first, and largest, studies to demonstrate an impact [of statin treatment] on adverse limb outcomes in patients with PAD, including worsening claudication, new critical limb ischemia, need for revascularization, and notably need for ischemic amputations. But despite having a class I recommendation for use in patients with PAD, data from this large, international registry suggest that statin use remains suboptimal," said Dr. Kumbhani, an interventional cardiologist at the University of Texas Southwestern Medical Center in Dallas.
"Future research should focus on improving patient and physician compliance with statin use across the entire spectrum of PAD patients," he said.
Concomitant coronary artery disease, as well as the specialty of the treating physician, seemed to link with statin use in these patients, Dr. Kumbhani added. "In PAD patients with CAD, statin use occurred in about 75%; in PAD patients without CAD, it was less than 50%."
Statins were most reliably prescribed to PAD patients by cardiologists, who administered the drugs to about 80% of all their PAD patients, regardless of concomitant CAD. In contrast, vascular surgeons prescribed statins to fewer than half their PAD patients, and in those who did not have concomitant CAD, statin use fell to less than a third. About 70% of all patients enrolled in the registry received their treatment from a primary care physician.
The data came from the Reduction of Atherothrombosis for Continued Health (REACH) registry, which followed more than 45,000 enrolled patients for at least 4 years at more than 3,600 centers in 29 countries; more than a quarter were U.S. patients (JAMA 2010;304:1350-7). Enrolled patients were at least 45 years old and had at least three atherosclerosis risk factors or established vascular disease in the coronary, cerebral, or peripheral domains. The enrolled patients included 5,861 with established, symptomatic PAD, of whom 3,643 (62%) were on statin treatment at the time they entered the registry.
During 4-year follow-up the rate of the primary systemic outcome – a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke – decreased by a statistically significant, relative 15% among patients on a statin compared with those not on a statin at baseline, in a propensity-score adjusted analysis.
Statin use linked with a statistically significant, 21% relative drop in worsening PAD events, compared with nonuse, in the propensity-score adjusted model. Adjusted analyses also showed statistically significant reductions for most of the individual outcomes that formed the composites, including a 27% relative reduction in nonfatal strokes and a 43% relative drop in limb amputations.
The systemic benefits seen in the registry from statin use in patients with PAD are consistent with results from randomized, controlled trials, but finding statin use also linked with decreased adverse limb outcomes is new, Dr. Kumbhani said.
The REACH registry is funded by Sanofi and Bristol-Myers Squibb. Dr. Kumbhani reported having no relevant financial disclosures.
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