Blog | Friday, November 22, 2013

QD: News Every Day--Statins may have positive effect on cardio events in critical limb ischemia

Statins are associated with less mortality and fewer major adverse cardiovascular and cerebrovascular events, as well as more amputation-free survival in patients with critical limb ischemia (CLI), a study found.

Corresponding author John R. Laird, MD, FACP and colleagues looked at 380 CLI patients, 246 (65%) of whom were prescribed statins, who were treated longitudinally at a multidisciplinary vascular center and who underwent diagnostic angiography or therapeutic endovascular intervention between 2006 and 2012.

Results appeared in the Journal of the American College of Cardiology.

The mean LDL cholesterol level was lower in patients prescribed statins (75±28 vs. 96±40 mg/dL, P<0.001). Patients taking statins had more comorbidity, including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all P<0.05).

Statin therapy was associated with lower one-year rates of major adverse cardiovascular and cerebrovascular events (MACCE), defined as any death, myocardial infarction, or stroke, within one year post-procedure. Statins users had lower rates of major events (HR, 0.53; 95% CI 0.28 to 0.99) and mortality (HR, 0.49; 95% CI 0.24 to 0.97). There were non-statistically significant trends in favor of statins for MI (HR, 0.48; 95% CI, 0.16 to 1.44), stroke (HR, 0.18; 95% CI, 0.02 to 1.78), and amputation (HR, 0.68; 95% CI, 0.32 to 1.39). The risk of death or major amputation was also significantly decreased in those prescribed statins (HR, 0.53; 95% CI, 0.35 to 0.98).

Among patients treated with statins, the group with baseline LDL cholesterol levels greater than 130 mg/dL had the highest unadjusted one-year event rate (22%). After adjusting for variables, there were decreased levels of MACCE among patients taking statins with baseline LDL levels greater than 130 compared to levels of 100-130 (HR, 0.51; 95% CI, 0.32 to 0.80), 70-100 (HR, 0.54; 95% CI, 0.36 to 0.83), and less than 70 (HR, 0.71; 95% CI, 0.48 to 1.05).

Researchers wrote, “The improved rates of one-year MACCE with statin use strengthens the evidence supporting the guideline recommendations of statin therapy for all PAD patients, including those with even the most advanced stages of disease.”

In an editorial, Michael R. Jaff, DO, FACP, wrote, “It is exciting to learn through this retrospective single center propensity analysis that aggressive statin therapy may not only reduce myocardial infarction, stroke, and death, but may actually improve limb survival in the most advanced PAD patients. ... This certainly provides motivation for a prospective analysis of patients with all manifestations of PAD, including those with ischemic rest pain and non-healing ischemic ulcerations, treated with statin therapy to aggressively low LDL-cholesterol levels, and include imaging of treated arterial segments.”