Study Shows Adherence to Statin Therapy Drives Survival of Patients With Symptomatic PAD
September 3, 2019—The European Society of Cardiology (ESC) announced the presentation of a study showing that statins are linked with reduced mortality in patients with peripheral artery disease (PAD), even when started late after diagnosis. Additionally, patients who stop the drug are at similar risk to those who have never taken it.
The study was presented at the ESC Congress 2019, held with the World Congress of Cardiology from August 31 to September 4 in Paris, France.
Although statins are recommended for all patients with PAD and are known to diminish the risk of stroke and heart attack by reducing low-density lipoprotein (LDL) cholesterol, adherence to statins is low. During the past 5 years, only 57% of patients in Europe took the medication as directed. In 2016 to 2017, only one-third of patients on statins reached the LDL-cholesterol target of below 1.8 mmol/L (70 mg/dL).
According to the ESC, the research shows the importance of starting and adhering to lifelong medication, preferably at a high dose. The study examined whether adherence to statin therapy influenced survival in patients with symptomatic PAD. The study enrolled 691 patients admitted to the hospital between 2010 and 2017 and followed for a median of 50 months.
At the beginning of the study, 73% of patients were on statins, increasing to 81% at the 50-month follow-up. The drug dose also increased between the two time periods, which was paralleled by a significant drop in LDL cholesterol from 97 mg/dL to 82 mg/dL.
The ESC reported that patients who stopped taking a statin had a similar mortality rate (33%) to those who never took the drug (34%). Adhering to statins throughout the 50 months was linked with a 20% rate of death. Taking high-dose statins throughout the study was linked with the lowest mortality rate (10%), while reducing the dosage during the study was related to the highest death rate (43%).
Study investigator Jörn Dopheide, MD, of Bern University Hospital in Bern, Switzerland, commented in the ESC announcement, “The study shows that adherence to statins is essential for the best prognosis. We also show that it is never too late to start medication and benefit from it. On top of that, it is crucial not to reduce the dose because LDL cholesterol levels rise again, thus increasing the overall risk on top of the residual risk for further events.”
Dr. Dopheide concluded, “All PAD patients should take statins, preferably very potent statins, like rosuvastatin 40 mg or atorvastatin 80 mg, or at the highest tolerable dose. In the rare case of statin intolerance, which was around 2% in our study, alternative lipid lowering therapies must be considered.”