Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia

Gregory G. Westin, Ehrin J. Armstrong, Heejung Bang, Khung Keong Yeo, David Anderson, David L Dawson, William C Pevec, Ezra A Amsterdam, John R. Laird

Research output: Contribution to journalArticle

91 Citations (Scopus)

Abstract

Objectives The aim of this study was 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 associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain. Methods We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. Results Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl 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 values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL. Conclusions Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.

Original languageEnglish (US)
Pages (from-to)682-690
Number of pages9
JournalJournal of the American College of Cardiology
Volume63
Issue number7
DOIs
StatePublished - Feb 25 2014

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
Amputation
Disease-Free Survival
Ischemia
Extremities
Mortality
Peripheral Arterial Disease
LDL Lipoproteins
Propensity Score
Secondary Prevention
Ulcer
Angiography
Survival
Therapeutics
Serum

Keywords

  • lipids and lipoproteins
  • major adverse cardiac event(s)
  • peripheral artery disease
  • secondary prevention
  • statin therapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia. / Westin, Gregory G.; Armstrong, Ehrin J.; Bang, Heejung; Yeo, Khung Keong; Anderson, David; Dawson, David L; Pevec, William C; Amsterdam, Ezra A; Laird, John R.

In: Journal of the American College of Cardiology, Vol. 63, No. 7, 25.02.2014, p. 682-690.

Research output: Contribution to journalArticle

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abstract = "Objectives The aim of this study was 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 associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain. Methods We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. Results Statins were prescribed for 246 (65{\%}) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl 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 values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95{\%} confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95{\%} CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95{\%} CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL. Conclusions Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.",
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T1 - Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia

AU - Westin, Gregory G.

AU - Armstrong, Ehrin J.

AU - Bang, Heejung

AU - Yeo, Khung Keong

AU - Anderson, David

AU - Dawson, David L

AU - Pevec, William C

AU - Amsterdam, Ezra A

AU - Laird, John R.

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N2 - Objectives The aim of this study was 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 associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain. Methods We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. Results Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl 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 values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL. Conclusions Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.

AB - Objectives The aim of this study was 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 associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain. Methods We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins. Results Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl 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 values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL. Conclusions Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.

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KW - secondary prevention

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