Study Shows Statins Improve Limb Salvage and Survival Rates After Intervention for PAD

 

August 5, 2019—The Society for Vascular Surgery (SVS) announced the publication of a study showing that patients with peripheral artery disease (PAD) were significantly less likely to undergo amputation after surgical intervention if they were on statin medications. Additionally, fewer deaths occurred in this group of patients over the 88-month review period. Gaurav M. Parmar, MD, et al published the findings in Journal of Vascular Surgery (JVS; 2019;70:539–546).

According to SVS, the retrospective analysis reviewed 488 patients undergoing either endovascular (n = 191) or open (n = 297) revascularization for PAD in 2009–2010 at the University of Alabama in Birmingham, Alabama.

In the study, 41% of patients were taking a statin and 56% were taking antiplatelet medications. For patients with PAD who were naive to statins, the investigators' protocol involved starting 20 mg simvastatin at the time of intervention, increasing this to 40 mg in clinic at follow-up, then up to 80 mg if there was an indication for a high dose.

The investigators reported that the use of statins was associated with improved survival at 5 years (89% vs 78; P < .001). Further, statin use at time of intervention was found to be significantly protective against amputation with a hazard ratio of 0.31. Antiplatelet therapy was associated with improved survival but not limb salvage.

Dr. Parmar commented in the SVS press release, “An important finding from this study is that the prevalence of both statin and antiplatelet therapy was low in our patient population, despite the known cardiovascular benefits. This may be due to lack of physician awareness or a major focus on limb-related rather than cardiovascular outcomes.” He continued, “Patients with PAD continue to receive suboptimal medical therapy compared with patients with CAD owing to a lack of physician awareness, presence of atypical symptoms, or a major focus on limb-related rather than cardiovascular outcomes. Efforts are ongoing within our vascular division to improve use of these medications across our institution.”

SVS noted that several years ago, the Vascular Quality Initiative established the prescribing of antiplatelets and statins for vascular patients at discharge as its first national quality initiative. In the study published in JVS, the investigators also recommend that statins be prescribed to PAD patients who have undergone vascular intervention.

Additionally, SVS advised that the 2016 American Heart Association PAD guidelines recommend statin therapy for all patients with PAD on the basis of reduced cardiovascular morbidity and mortality (class I recommendation). Statin therapy both lowers cholesterol levels and stabilizes atherosclerotic plaque due to its anti-inflammatory properties.

“We feel like the benefits of statin therapy are so critical to outcomes in the treatment of vascular disease that we have begun taking the responsibility of prescribing within our practice,” concluded study investigator Benjamin J. Pearce, MD, in the SVS announcement.

 

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