Abstract 669: Aggressive Cholesterol Reduction with High-Dose Statins Improves Prognosis in Peripheral Arterial Disease
Background: LDL-cholesterol lowering drugs are associated with an improved long-term outcome in patients with peripheral atherosclerotic disease (PAD).
Aim: To assess the independent effect of statins and aggressive LDL-cholesterol reduction in patients with PAD.
Methods: In this prospective observational cohort study, 1374 consecutive patients with PAD were screened for risk factors, duration of statin therapy and statin dose (% of maximum recommended dose). Serial cholesterol levels were obtained at baseline, 6 months and 1 year. During 6 years of follow-up, cardiac death was noted. A subanalysis was performed to compare potent statins (atorvastatin and rosuvastatin) vs less potent statins (simvastatin, fluvastatin and pravastatin).
Results: Cardiac death occurred in 20% of patients, with the lowest rate (13%) in patients with LDL-C levels <70 mg/dl. In multivariate analysis, long-term (HR: 0.28 (0.17– 0.46)) and newly prescibed statin users (HR: 0.44 (0.29 – 0.68)) were at decreased risk of cardiac death, compared to patients with no statins. In addition, higher statin doses (HR per 10%: 0.71 (0.63– 0.80)), higher LDL-C reduction (HR per 10%: 0.94 (0.90 – 0.98)), and lower target LDL-C levels (per 10 mg/dl: 0.95 (0.93– 0.98)) were associated with reduced cardiac death. Despite differences in LDL-C reduction between potent and less potent statins, mortality rates were comparable (Figure⇓).
Conclusion: Longer statin use, higher statin dose and agressive LDL-C reduction improve prognosis in PAD. Patients wiht target LDL-C < 70 mg/dl had the best prognosis. The independent beneficial effect of statin therapy may be explained by pleiotropic effects.