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. 2014 Nov 1;35(41):2864-72.
doi: 10.1093/eurheartj/ehu080. Epub 2014 Feb 28.

Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry

Dharam J Kumbhani  1 , Ph Gabriel Steg  2 , Christopher P Cannon  3 , Kim A Eagle  4 , Sidney C Smith Jr  5 , Shinya Goto  6 , E Magnus Ohman  7 , Yedid Elbez  8 , Piyamitr Sritara  9 , Iris Baumgartner  10 , Subhash Banerjee  11 , Mark A Creager  12 , Deepak L Bhatt  13 ; REACH Registry Investigators
Affiliations

Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry

Dharam J Kumbhani et al. Eur Heart J. .

Abstract

Aims: Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry.

Methods: Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users.

Results: A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01).

Conclusion: Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.

Keywords: Claudication; Morbidity; Peripheral vascular disease; Registry; Statins.

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Figures

Figure 1
Figure 1
CONSORT flow diagram of study participants.
Figure 2
Figure 2
Proportion of patients on statins at enrolment.
Figure 3
Figure 3
Proportion of patients on statins at enrolment based on enrolling investigator's subspecialty. Also reported are proportions based on the presence of concomitant CAD or not. CAD indicates coronary artery disease.
Figure 4
Figure 4
Subgroup analysis of the effect of statin use on the composite adverse limb outcome at 4 years. CI, confidence intervals; HR, hazard ratio.
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