Abstract 4197: Statins and ACE-Inhibitors Prevent Renal Deterioration in Patients with Peripheral Arterial Disease
Background: Renal dysfunction is an underestimated risk factor in patients with peripheral atherosclerotic disease.
Aim: To assess the prevalence and prognosis of decreased estimated glomerular filtration rate (eGFR) in patients with peripheral atherosclerotic disease and to evaluate whether statins and angiotensin-convering enzyme (ACE-) inhibitors are associated with reduced renal deterioration and reduced cardiovascular event rate.
Methods: In a prospective observational cohort study of 1939 consecutive patients with peripheral arterial disease, clinical characteristics, cardiac medication and serial creatinine concentrations were obtained. During follow-up, renal deterioration (>25% decrease in eGFR) was determined and hard cardiac events (cardiac death or non-fatal myocardial infarction) were noted.
Results: No, mild, moderate and severe renal dysfunction (eGFR of >75, 60.0–74.9, 45.0–59.9, and <45.0 ml/min per 1.73 m2, respectively), was assessed in 55%, 19%, 14% and 12% of patients. Renal deterioration occurred in 9%, 8%, 13%, and 20% of patients, respectively. Hard cardiac events during a mean follow-up of 6.4 years occurred in 20%, 27%, 30%, and 32% of patients, respectively. Statins and ACE-inhibitors were significantly associated with reduced renal deterioration (HR: 0.62, 95% CI: 0.49– 0.79, and HR: 0.55, 95% CI: 0.44– 0.70, respectively). In multivariate Cox proportional hazard regression analysis, lower baseline eGFR (per 10 mg/min/1.73 m2) and higher decreases in eGFR (per 10%) were significantly associated with a higher hazard of hard cardiac events (HR: 1.16, 95% CI: 1.12–1.21 and HR: 1.07, 95% CI: 1.02–1.11, respectively). In patients with mild, moderate or severe renal dysfunction, statins and ACE-inhibitors were both associated with a reduction in hard cardiac event rate (HR: 0.60, 95% CI: 0.38–0.87 and HR: 0.65 (0.46–0.92), respectively), after adjusment for possible confounding risk factors and propensity scores.
Conclusion: Abnormal eGFR and deterioration in eGFR are frequently observed in PAD and carry an adverse prognosis. Statins and ACE-inhibitors are associated with a reduction in renal deterioration and both drugs improve cardiovascular outcome in PAD patients with renal dysfunction.