Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia

Abstract

Objectives To determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients. Background CLI is an advanced form of peripheral arterial disease (PAD) associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. While statin medications are recommended for secondary prevention in PAD, their effectiveness in CLI is uncertain. Methods We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006–2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. Results 246 (65%) patients were prescribed statins. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75±28 vs. 96±40 mg/dL, P<0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all P <0.05). After propensity weighting, statin therapy was associated with lower one-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR] 0.53, 95% CI 0.28–0.99), mortality (HR 0.49, 95% CI 0.24–0.97), and major amputation or death (HR 0.53, 95% CI 0.35–0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels above 130mg/dL had increased hazards of MACCE and mortality compared to patients with lower levels of LDL. Conclusions Statins are associated with lower mortality and MACCE and increased amputation-free survival in CLI patients.

Impact of Objective Malnutrition Status on the Clinical Outcomes in Patients With Peripheral Artery Disease Following Endovascular Therapy

“…Recent study demonstrated the protective role of statins in patients with PAD. 33, 34 Although similar results were found in the present study, statins may be prescribed for patients who had a favorable nutritional status. Further study is needed to reveal the beneficial role of statins on the nutritional status.…”

Statin use is associated with improved overall survival without affecting patency and limb salvage rates following open or endovascular revascularization

“…Although there are a number of studies showing improved survival in patients on statins after vascular surgical procedures [14][15][16][17][18]21 or in those with a diagnosis of PAD, 10 there are a few that included only patients with peripheral revascularization procedures. [11][12][13][14][15] Only three of these studies showed survival benefit. [13][14][15] Schanzer et al reported a survival benefit at 1 year (86% vs 81%) with statins in their cohort of patients with CLI who participated in the PREVENT III trial.…”

Higher Serum Levels of Osteoglycin Are Associated with All-Cause Mortality and Cardiovascular and Cerebrovascular Events in Patients with Advanced Chronic Kidney Disease

“…Cardiac death was defined as mortality due to a heart-related cause (death attributable to ACS, heart failure, arrhythmia, or sudden cardiac death) (Muhlestein et al 2014). Stroke was defined as typical symptoms or signs of remaining neurological deficit lasting > 24 hours with computed tomography or magnetic resonance imaging evidence of cerebral ischemic infarct or intracerebral hemorrhage (Westin et al 2014).…”