Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease.

Ehrin J. Armstrong, Debbie C. Chen, Gregory G. Westin, Satinder Singh, Caroline E. McCoach, Heejung Bang, Khung Keong Yeo, David Anderson, Ezra A Amsterdam, John R. Laird

Research output: Contribution to journalArticle

101 Citations (Scopus)

Abstract

Current guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statin medications, and angiotensin-converting enzyme (ACE) inhibitors. The combined effects of multiple guideline-recommended therapies in patients with symptomatic PAD have not been well characterized. We analyzed a comprehensive database of all patients with claudication or critical limb ischemia (CLI) who underwent diagnostic or interventional lower-extremity angiography between June 1, 2006 and May 1, 2013 at a multidisciplinary vascular center. Baseline demographics, clinical data, and long-term outcomes were obtained. Inverse probability of treatment propensity weighting was used to determine the 3-year risk of major adverse cardiovascular or cerebrovascular events (MACE; myocardial infarction, stroke, or death) and major adverse limb events (MALE; major amputation, thrombolysis, or surgical bypass). Among 739 patients with PAD, 325 (44%) had claudication and 414 (56%) had CLI. Guideline-recommended therapies at baseline included use of aspirin in 651 (88%), statin medications in 496 (67%), ACE inhibitors in 445 (60%), and smoking abstention in 528 (71%) patients. A total of 237 (32%) patients met all four guideline-recommended therapies. After adjustment for baseline covariates, patients adhering to all four guideline-recommended therapies had decreased MACE (hazard ratio [HR], 0.64; 95% CI, 0.45 to 0.89; P=0.009), MALE (HR, 0.55; 95% CI, 0.37 to 0.83; P=0.005), and mortality (HR, 0.56; 95% CI, 0.38 to 0.82; P=0.003), compared to patients receiving less than four of the recommended therapies. In patients with claudication or CLI, combination treatment with four guideline-recommended therapies is associated with significant reductions in MACE, MALE, and mortality.

Original languageEnglish (US)
JournalJournal of the American Heart Association
Volume3
Issue number2
StatePublished - 2014

Fingerprint

Guideline Adherence
Peripheral Arterial Disease
Extremities
Guidelines
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Therapeutics
Ischemia
Angiotensin-Converting Enzyme Inhibitors
Aspirin
Smoking
Mortality
Amputation
Blood Vessels
Lower Extremity
Angiography
Stroke
Myocardial Infarction
Demography
Databases

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease. / Armstrong, Ehrin J.; Chen, Debbie C.; Westin, Gregory G.; Singh, Satinder; McCoach, Caroline E.; Bang, Heejung; Yeo, Khung Keong; Anderson, David; Amsterdam, Ezra A; Laird, John R.

In: Journal of the American Heart Association, Vol. 3, No. 2, 2014.

Research output: Contribution to journalArticle

Armstrong, Ehrin J. ; Chen, Debbie C. ; Westin, Gregory G. ; Singh, Satinder ; McCoach, Caroline E. ; Bang, Heejung ; Yeo, Khung Keong ; Anderson, David ; Amsterdam, Ezra A ; Laird, John R. / Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease. In: Journal of the American Heart Association. 2014 ; Vol. 3, No. 2.
@article{1e83fa09e6ec46fea8c7a87737179705,
title = "Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease.",
abstract = "Current guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statin medications, and angiotensin-converting enzyme (ACE) inhibitors. The combined effects of multiple guideline-recommended therapies in patients with symptomatic PAD have not been well characterized. We analyzed a comprehensive database of all patients with claudication or critical limb ischemia (CLI) who underwent diagnostic or interventional lower-extremity angiography between June 1, 2006 and May 1, 2013 at a multidisciplinary vascular center. Baseline demographics, clinical data, and long-term outcomes were obtained. Inverse probability of treatment propensity weighting was used to determine the 3-year risk of major adverse cardiovascular or cerebrovascular events (MACE; myocardial infarction, stroke, or death) and major adverse limb events (MALE; major amputation, thrombolysis, or surgical bypass). Among 739 patients with PAD, 325 (44{\%}) had claudication and 414 (56{\%}) had CLI. Guideline-recommended therapies at baseline included use of aspirin in 651 (88{\%}), statin medications in 496 (67{\%}), ACE inhibitors in 445 (60{\%}), and smoking abstention in 528 (71{\%}) patients. A total of 237 (32{\%}) patients met all four guideline-recommended therapies. After adjustment for baseline covariates, patients adhering to all four guideline-recommended therapies had decreased MACE (hazard ratio [HR], 0.64; 95{\%} CI, 0.45 to 0.89; P=0.009), MALE (HR, 0.55; 95{\%} CI, 0.37 to 0.83; P=0.005), and mortality (HR, 0.56; 95{\%} CI, 0.38 to 0.82; P=0.003), compared to patients receiving less than four of the recommended therapies. In patients with claudication or CLI, combination treatment with four guideline-recommended therapies is associated with significant reductions in MACE, MALE, and mortality.",
author = "Armstrong, {Ehrin J.} and Chen, {Debbie C.} and Westin, {Gregory G.} and Satinder Singh and McCoach, {Caroline E.} and Heejung Bang and Yeo, {Khung Keong} and David Anderson and Amsterdam, {Ezra A} and Laird, {John R.}",
year = "2014",
language = "English (US)",
volume = "3",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Adherence to guideline-recommended therapy is associated with decreased major adverse cardiovascular events and major adverse limb events among patients with peripheral arterial disease.

AU - Armstrong, Ehrin J.

AU - Chen, Debbie C.

AU - Westin, Gregory G.

AU - Singh, Satinder

AU - McCoach, Caroline E.

AU - Bang, Heejung

AU - Yeo, Khung Keong

AU - Anderson, David

AU - Amsterdam, Ezra A

AU - Laird, John R.

PY - 2014

Y1 - 2014

N2 - Current guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statin medications, and angiotensin-converting enzyme (ACE) inhibitors. The combined effects of multiple guideline-recommended therapies in patients with symptomatic PAD have not been well characterized. We analyzed a comprehensive database of all patients with claudication or critical limb ischemia (CLI) who underwent diagnostic or interventional lower-extremity angiography between June 1, 2006 and May 1, 2013 at a multidisciplinary vascular center. Baseline demographics, clinical data, and long-term outcomes were obtained. Inverse probability of treatment propensity weighting was used to determine the 3-year risk of major adverse cardiovascular or cerebrovascular events (MACE; myocardial infarction, stroke, or death) and major adverse limb events (MALE; major amputation, thrombolysis, or surgical bypass). Among 739 patients with PAD, 325 (44%) had claudication and 414 (56%) had CLI. Guideline-recommended therapies at baseline included use of aspirin in 651 (88%), statin medications in 496 (67%), ACE inhibitors in 445 (60%), and smoking abstention in 528 (71%) patients. A total of 237 (32%) patients met all four guideline-recommended therapies. After adjustment for baseline covariates, patients adhering to all four guideline-recommended therapies had decreased MACE (hazard ratio [HR], 0.64; 95% CI, 0.45 to 0.89; P=0.009), MALE (HR, 0.55; 95% CI, 0.37 to 0.83; P=0.005), and mortality (HR, 0.56; 95% CI, 0.38 to 0.82; P=0.003), compared to patients receiving less than four of the recommended therapies. In patients with claudication or CLI, combination treatment with four guideline-recommended therapies is associated with significant reductions in MACE, MALE, and mortality.

AB - Current guidelines recommend that patients with peripheral arterial disease (PAD) cease smoking and be treated with aspirin, statin medications, and angiotensin-converting enzyme (ACE) inhibitors. The combined effects of multiple guideline-recommended therapies in patients with symptomatic PAD have not been well characterized. We analyzed a comprehensive database of all patients with claudication or critical limb ischemia (CLI) who underwent diagnostic or interventional lower-extremity angiography between June 1, 2006 and May 1, 2013 at a multidisciplinary vascular center. Baseline demographics, clinical data, and long-term outcomes were obtained. Inverse probability of treatment propensity weighting was used to determine the 3-year risk of major adverse cardiovascular or cerebrovascular events (MACE; myocardial infarction, stroke, or death) and major adverse limb events (MALE; major amputation, thrombolysis, or surgical bypass). Among 739 patients with PAD, 325 (44%) had claudication and 414 (56%) had CLI. Guideline-recommended therapies at baseline included use of aspirin in 651 (88%), statin medications in 496 (67%), ACE inhibitors in 445 (60%), and smoking abstention in 528 (71%) patients. A total of 237 (32%) patients met all four guideline-recommended therapies. After adjustment for baseline covariates, patients adhering to all four guideline-recommended therapies had decreased MACE (hazard ratio [HR], 0.64; 95% CI, 0.45 to 0.89; P=0.009), MALE (HR, 0.55; 95% CI, 0.37 to 0.83; P=0.005), and mortality (HR, 0.56; 95% CI, 0.38 to 0.82; P=0.003), compared to patients receiving less than four of the recommended therapies. In patients with claudication or CLI, combination treatment with four guideline-recommended therapies is associated with significant reductions in MACE, MALE, and mortality.

UR - http://www.scopus.com/inward/record.url?scp=84904611110&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84904611110&partnerID=8YFLogxK

M3 - Article

VL - 3

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

ER -