Abstract 16162: Statin Therapy is Associated with Decreased Major Adverse Cardiovascular Events in Patients with Critical Limb Ischemia
Introduction Statin therapy is associated with improved cardiovascular outcomes in patients with coronary artery disease. Statins are also recommended for patients with peripheral arterial disease (PAD), but most of this data is based on clinical trials of patients with stable claudication. Patients with critical limb ischemia (CLI), a severe form of PAD characterized by ischemic rest pain or tissue loss, are at increased risk of cardiovascular events and premature death. This high risk patient population may stand to benefit the most from statin therapy.
Hypothesis We hypothesized that statin therapy for patients with CLI would be associated with lower rates of major adverse cardiovascular events (MACE, defined as death, myocardial infarction, or stroke) and lower all-cause mortality.
Methods We analyzed data on all patients with CLI in the UCD-PAD Registry who underwent diagnostic or interventional lower extremity angiography at UC Davis Medical Center between 2006 and 2011. Baseline demographics, clinical data, and long-term follow-up were obtained through review of electronic medical records. Kaplan Meier analysis and Cox proportional hazard modeling were used to determine the long-term risk of MACE and mortality.
Results Among 219 patients with CLI, 144 (66%) were taking a statin at the time of angiography. Patients prescribed a statin had higher prevalence of coronary artery disease (61 vs. 22%, p < 0.001) and also had lower baseline LDL than patients not prescribed a statin (74 vs. 91 mg/dl, p = 0.02). Statin therapy was associated with lower subsequent mortality and lower rates of MACE (figure). After adjusting for baseline covariates including use of beta blockers, ACE inhibitors, aspirin, and clopidogrel, statin use was associated with lower risk of mortality (HR 0.38 [95% CI 0.15-0.93], p = 0.03) and MACE (HR 0.32 [95% CI 0.14-0.73], p = 0.006).
Conclusions In patients with CLI, statin therapy is associated with significant reduction in mortality and MACE.
- © 2012 by American Heart Association, Inc.