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Eur Heart J. 2014 Nov 1;35(41):2864-72. doi: 10.1093/eurheartj/ehu080. Epub 2014 Feb 28.

Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry.

Author information

  • 1Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA dharam@post.harvard.edu.
  • 2Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK.
  • 3Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA.
  • 4University of Michigan Cardiovascular Center, Ann Arbor, MI, USA.
  • 5Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
  • 6Department of Medicine, Tokai University School of Medicine, Isehara, Japan.
  • 7Division of Cardiology, Duke University, Durham, NC, USA.
  • 8Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.
  • 9Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
  • 10Swiss Cardiovascular Center Bern, University Hospital Bern, Switzerland.
  • 11Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA.
  • 12Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
  • 13Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA.

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.

Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

KEYWORDS:

Claudication; Morbidity; Peripheral vascular disease; Registry; Statins

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