Statins and Major Adverse Limb Events in Patients with Peripheral Artery Disease: A Systematic Review and Meta-Analysis

Pastori, Daniele; Farcomeni, Alessio; Milanese, Alberto; Sole, Francesco; Menichelli, Danilo; Hiatt, William R.; Violi, Francesco

doi:10.1055/s-0040-1709711

Cited by 67 publications

(47 citation statements)

References 76 publications

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“…A recent metanalysis has shown that statin therapy may prevent limb events in patients with PAD 31 . In our study, patients with PAD were more prone to receive statin therapy; however, in the light of this recent publication statin therapy should be more widely implemented.…”

Section: Discussionmentioning

confidence: 53%

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A report from the FANTASIIA registry

Bertomeu‐González

Moreno‐Arribas

Esteve‐Pastor

et al. 2020

Eur J Clin Investigation

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Background Atrial fibrillation (AF) and peripheral artery disease (PAD) are common conditions that increase cardiovascular risk. We determined the association between PAD and prognosis in a cohort of real‐world patients receiving oral anticoagulant therapy for nonvalvular AF. Methods We prospectively included 1956 patients (mean age 73.8 ± 9.5 years, 44.0% women) receiving oral anticoagulant therapy for AF. Clinical characteristics were collected at baseline. Patients were followed for a period of 3 years. Survival analysis and multivariable regression analyses were performed to assess variables related to death, stroke, bleeding, myocardial infarction and major adverse cardiovascular events (MACE). Results Patients with PAD (n = 118; 6%) exhibited higher rates of cardiovascular risk factors and cardiovascular diseases. After 3 years of follow‐up, there were a total of 255 deaths (no PAD 233, vs PAD 22), 45 strokes (43 vs 2), 146 major bleedings (136 vs 10) and 168 MACE (148 vs 20). On univariate analysis, there was a higher risk of cardiovascular mortality (2.02%/year no PAD vs 4.08%/year PAD, P = .02), myocardial infarction (0.99%/year no PAD vs 2.43%/year PAD, P = .02) and MACE (3.18%/year no PAD vs 6.99%/year PAD, P < .01). There was no statistically significant association with these events after multivariable adjustment. Conclusions In a large cohort of anticoagulated patients with AF, the presence of PAD represents a higher risk subgroup and is associated with worse crude outcomes. The exact contribution of the PAD independently of other cardiovascular diseases or risk factors requires further investigation.

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Section: Discussionmentioning

confidence: 53%

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A report from the FANTASIIA registry

Bertomeu‐González

Moreno‐Arribas

Esteve‐Pastor

et al. 2020

Eur J Clin Investigation

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“…46 Its cost-effectiveness and budget impact were highlighted by Cortesi et al 47 Often underestimated, the risk of major adverse limb events is unfortunately very high in patients with peripheral artery disease. Pastori et al 48 reported a well relayed comprehensive meta-analysis to alert physicians on the positive impact of statins for this group of patients.…”

Section: Aside From Anticoagulationmentioning

confidence: 99%

Thrombosis and Haemostasis 2020 Editors' Choice Papers

2021

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In this Editor's choice, we highlight last year's papers from Thrombosis and Haemostasis as well as from its open access companion journal THOpen, which found most resonance among our readers' community, holding promise for mechanistic understanding and improved clinical management in the fields of Thrombosis and Haemostasis. Building on the research investigations from this undoubtedly memorable year may be particularly useful to overcome the current pandemic situation. As it became apparent that coronavirus disease 2019 (COVID-19) was not merely a pulmonary disease but that thrombosis was a key element involved in its severity and complications, the thrombosis research community deployed intensive research efforts in the hope to optimize treatment and/or prophylaxis as well as to decipher the mechanisms and characteristics of COVID-19 thrombosis as rapidly as possible. Due to the urgency of the pandemic development, it was indeed not surprising that publications relating to COVID-19 received by far the most attention in 2020. Unprecedented Research Efforts for Unprecedented TimesEarly on into the pandemic, Lippi and Favaloro 1 proposed the simple D-dimer test for prognosis of COVID-19 severity in a short T&H report which received particular resonance. By using classic coagulation tests together with point-of-care methods such as whole blood thromboelastometry, Spiezia et al 2 further reported specific coagulation alterations, thereby identifying a state of severe hypercoagulability in COVID-19 patients with acute respiratory failure. The systematic review and meta-analysis from Jin et al 3 described the coagulation abnormalities seen in Chinese patients with COVID-19. Boscolo et al comparatively assessed the values of different coagulation tests between patients admitted to internal medicine department versus intensive care unit. 4 Beyond this hypercoagulation state, Violi et al extensively reviewed how clotting variables behave and impact on the severity of COVID-19 along with potential antithrombotic treatment options in COVID-19. 5 Marchandot et al proposed that haemostatic abnormalities could be used to help stage severity of To help thrombosis specialists, investigators, and funders, a truly multidisciplinary collaborative group of experts in disciplines including cardiovascular diseases, hematology, vascular medicine, pharmacy and pharmacology, pulmonary and critical care medicine, laboratory medicine, and health policy joined efforts to form the Global COVID-19 Thrombosis Collaborative Group. Their position paper 7 comprehensively discussed classical anticoagulants, antiplatelet drugs, and their anti-inflammatory mechanisms and also agents that modulate inflammation and may thus help to mitigate thromboinflammation. While a panel of experts from China and Europe published a consensus statement with practical guidelines for the prevention and treatment of venous thromboembolism (VTE) associated with COVID-19, 8 Grandmaison et al highlighted the benefits of systematic VTE screening in COVID-19 patients. 9...

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“…Venous thromboembolism (VTE) has an estimated annual incidence rate of 1–2 per 1000 person-years among people of European ancestry [ 1 ]. The 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, the so-called statins, are a class of lipid-lowering drugs widely used to prevent arterial atherosclerotic disease [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Differential effect of statin use on coagulation markers: an active comparative analysis in the NEO study

et al. 2021

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Background Statins are a potential treatment for venous thromboembolism (VTE) prophylaxis complementary to conventional anticoagulants without associated bleeding complications. This study aimed to compare pro-thrombotic activities of different classes of lipid-lowering drugs in an active comparator design and determine whether there is a relation between statin versus fibrate/niacin use and pro-coagulant factor outcomes. Methods This is a cross-sectional analysis of participants from the Netherlands Epidemiology of Obesity study using any class of lipid-lowering drugs, including any types of statins, niacin, and fibrates. We performed linear regression analyses to determine fibrinogen, factor (F) VIII, FIX, and FXI activity in statins versus fibrate/niacin users and adjusted for age, sex, tobacco smoking, body mass index (BMI), hypertension, diabetes, and prevalent cardiovascular disease. Results Among 1043 participants, the mean age was 58.4 ± 5.2 years, 61% were men, and the mean BMI was 31.3 ± 4.5 kg/m2. Clinical characteristics were balanced between statin and fibrate/niacin users. Statin users had lower mean FXI (18.3 IU/dL, 95% confidence interval (CI) 9.4 to 27.3) levels compared to fibrate/niacin users. The level of FVIII (15.8 IU/dL, 95% CI − 0.003 to 31.6), and FIX (11.3 IU/dL, 95% CI − 0.4 to 23.2) were lower in statin users than fibrate/niacin users with marginal statistical significance. Conclusion Current statin use was associated with lower plasma levels of FXI than fibrate/niacin use. The effects on coagulation factors may, in part, explain the benefit of statin therapy rendered in primary and secondary prevention of VTE.

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Statins and Major Adverse Limb Events in Patients with Peripheral Artery Disease: A Systematic Review and Meta-Analysis

Cited by 67 publications

References 76 publications

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A report from the FANTASIIA registry

Peripheral artery disease and clinical outcomes in patients with atrial fibrillation: A report from the FANTASIIA registry

Thrombosis and Haemostasis 2020 Editors' Choice Papers

Differential effect of statin use on coagulation markers: an active comparative analysis in the NEO study

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