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J Endovasc Ther. 2019 Mar 15:1526602819836382. doi: 10.1177/1526602819836382. [Epub ahead of print]

Serum Low-Density Lipoprotein Cholesterol Level After Endovascular Therapy in Patients With Claudication.

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1
1 Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.

Abstract

PURPOSE:

To investigate the association between low-density lipoprotein cholesterol (LDL-C) levels and the 5-year cardiovascular death rate after endovascular therapy (EVT) in patients with lower limb peripheral artery disease (PAD) according to statin therapy status.

METHODS:

From January 2010 to March 2016, 1324 PAD patients (1670 limbs) with claudication (Rutherford category 1-3) underwent EVT. After excluding 389 patients owing to death or missing data, 935 (70.6%) patients (mean age 72.1±8.7 years; 708 men) were included in the analysis. Statin therapy was prescribed to 509 (54.4%) patients at discharge. LDL-C levels at 3 to 6 months after EVT were correlated with the incidence of cardiovascular death (CVD; procedure-related and proximate cardiac, noncoronary vascular, or unknown causes) at 5 years. A stratifying factor of 100 mg/dL was based on the median LDL-C value (94 mg/dL) in the cohort. Predictors of CVD were sought in multivariate analysis; results are presented as the hazard ratio (HR) and 95% confidence interval (CI).

RESULTS:

Over a median follow-up of 30.7 months (interquartile range 13.7, 47.6), CVD occurred in 83 (8.9%) patients. The incidence of CVD at 5 years was significantly higher in patients with LDL-C ≥100 mg/dL at 3 to 6 months than in those with LDL-C <100 mg/dL (23.5% vs 13.5%, p=0.03). In addition, LDL-C ≥100 mg/dL at 3 to 6 months was associated with a higher incidence of CVD (25.2% vs 10.9%, p=0.02) in 509 (54.4%) patients with statin therapy at discharge. In the multivariate model, LDL-C ≥100 mg/dL at 3 to 6 months after EVT was an independent predictor of CVD (adjusted HR 1.60, 95% CI 1.001 to 2.59, p=0.049).

CONCLUSION:

LDL-C ≥100 mg/dL at 3 to 6 months after the EVT for symptomatic lower limb PAD was independently associated with a higher risk of CVD, particularly in patients on statin therapy at discharge. This observation suggests that intensive LDL-C-lowering therapy may be needed to improve clinical outcomes.

KEYWORDS:

cardiovascular death; endovascular therapy; low-density lipoprotein cholesterol; peripheral artery disease; statin therapy

PMID:
30873910
DOI:
10.1177/1526602819836382

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