Comparison of Lipid Management in Patients With Coronary Versus Peripheral Arterial Disease

Sharma, Suresh; Thapa, Rashmi; Jeevanantham, Vinodh; Myers, Taylor; Hu, Casper; Brimacombe, Michael; Vacek, James L.; Dawn, Buddhadeb; Gupta, Kamal

doi:10.1016/j.amjcard.2014.01.405

Cited by 19 publications

(10 citation statements)

References 28 publications

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“…13,14 In addition, research to discover innovative effective therapies specifically for PAD is scanty. 13,[15][16][17] Epidemiological data on the prognosis of PAD patients largely derive from cohort studies done decades ago when the use of drugs for the prevention of cardio-cerebrovascular complications and arterial revascularization procedures was less frequent. 18 Studies describing more recent trends in therapeutic approaches and related outcomes of patients with PAD are still limited.…”

Section: Introductionmentioning

confidence: 99%

Peripheral arterial disease: Changes in clinical outcomes and therapeutic strategies in two cohorts, from 2002 to 2008 and from 2008 to 2014. A population-based study

Baviera

Bertelè

Avanzini

et al. 2018

Eur J Prev Cardiolog

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Background The aim of our study was to evaluate whether treatments for peripheral artery disease changed in two different cohorts identified in 2002 and 2008, and whether this had an impact on mortality and major clinical outcomes after six years of follow-up. Methods Using administrative health databases of the largest region in Northern Italy, we identified patients admitted to hospital for peripheral artery disease in 2002 and 2008. Both cohorts were followed for six years. All cause death, acute coronary syndrome, stroke and major amputations, cardiovascular prevention drugs and revascularization procedures were collected. Incidence of events was plotted using adjusted cumulative incidence function estimates. The risk, for each outcome, was compared between 2002-2008 and 2008-2014 using a multivariable Fine and Gray's semiparametric proportional subdistribution hazards model. Results In 2002 and 2008, 2885 and 2848 patients were identified. Adjusting for age, sex, Charlson comorbidity index and severity of peripheral artery disease we observed a significant reduction (in 2008 vs. 2002) in the risk of acute coronary syndrome (28%), stroke (27%) and major amputation (17%). No change was observed in the risk of death. The percentages of patients with peripheral artery revascularizations, during the hospital stay, increased: 43.8% in 2002 vs. 49.0% in 2008, p < 0.001. From 2002 to 2008 there was a significant absolute increase in the prescription of lipid-lowering drugs (+18%), antiplatelets (+7.2%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (+11.8%), p < 0.001. Conclusions In six years of follow-up we observed a reduction in risk of major cardiovascular events in 2008-2014 in comparison with the 2002-2008 cohort. Increasing use of revascularization interventions and cardiovascular prevention drugs could have contributed to the better prognosis.

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Section: Introductionmentioning

confidence: 99%

Peripheral arterial disease: Changes in clinical outcomes and therapeutic strategies in two cohorts, from 2002 to 2008 and from 2008 to 2014. A population-based study

Baviera

Bertelè

Avanzini

et al. 2018

Eur J Prev Cardiolog

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show abstract

“…17 More recently, a retrospective observational study demonstrated lower and less aggressive use of statins in patients with PAD versus those with coronary artery disease (CAD). 13 The use of risk factor modification in patients with symptomatic PAD who undergo LER is also low. 8,11,18 Conte and colleagues examined the medical therapy provided to 1403 patients who underwent infrainguinal bypass for critical limb ischemia as part of the PREVENT III trial.…”

Section: Discussionmentioning

confidence: 99%

“…11 The gap between ACCF/AHA guidelines and practice for PAD remains larger than the gap for other cardiovascular diseases (CVDs). 12,13 However, the relationship between these QoC measures and outcomes in patients with PAD is not as well established as it is for other CVDs.…”

Section: Introductionmentioning

confidence: 99%

Quality of care among patients undergoing lower extremity revascularization

et al. 2014

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Background: Compliance with guidelines for treating patients with peripheral artery disease (PAD) lags compliance for treating patients with coronary artery disease. We assessed the gap between guidelines and practice for patients with PAD who underwent lower extremity revascularization (LER) at our institution from 2007 to 2010. Methods: Quality of care (QoC) was calculated by measuring provider performance on four indicators (antiplatelet therapy, dyslipidemia management, control of hypertension, and diabetes) derived from the ACCF/AHA PAD guidelines. The QoC score was calculated at the time of admission and at time of discharge for each patient, and reflects the proportion of indicated treatments received. Results: Patients (n = 734, mean age 70±11, female 51%) were followed for a mean of 2.0±1.4 years (range 0-5.7) following LER. The indication for LER was claudication (24.8%), rest pain (16.7%), and tissue loss (58.4%). The percentage of patients with a perfect QoC score increased significantly during hospital admission (11% to 21%, p < 0.001). Significant multivariate predictors of perfect QoC score included race/ethnicity, Charlson score, severity of LE ischemia, and observation period (admission, discharge). Multivariate analysis demonstrated that age>75 years, heart failure, chronic kidney disease, rest pain, and tissue loss-but not compliance with four guideline-based therapies-were associated with decreased freedom from the composite endpoint of major amputation, repeat revascularization, and death. Conclusions: Although adherence to guidelines improved over time, we found a significant gap between guidelines and practice for this cohort of patients at increased risk for adverse cardiovascular events.

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“…Smoking cessation and exercise programs are proposed to alleviate symptoms. Drug treatment may be prescribed: 1) anticoagulants and/or antiplatelet/antithrombotic drugs (aspirin, clopidogrel) to prevent thrombus formation due to slow blood flow in microvessels [16]; 2) vasodilatory drugs to prevent platelet aggregation (patients with PAD have a systemic endothelial dysfunction associated with impaired vasodilation and enhanced platelet aggregation [17]; 3) antihypertensive drugs; and 4) cholesterol-lowering drugs [18]. There is a strong correlation between high low-density-lipoprotein cholesterol levels and PAD symptoms.…”

Section: Prevention Of Disease Progressionmentioning

confidence: 99%

Use of Marine Compounds to Treat Ischemic Diseases

Boisson-Vidal

2018

Blue Biotechnology

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Comparison of Lipid Management in Patients With Coronary Versus Peripheral Arterial Disease

Cited by 19 publications

References 28 publications

Peripheral arterial disease: Changes in clinical outcomes and therapeutic strategies in two cohorts, from 2002 to 2008 and from 2008 to 2014. A population-based study

Peripheral arterial disease: Changes in clinical outcomes and therapeutic strategies in two cohorts, from 2002 to 2008 and from 2008 to 2014. A population-based study

Quality of care among patients undergoing lower extremity revascularization

Use of Marine Compounds to Treat Ischemic Diseases

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