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Title: Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: Insights from the REACH registry
Authors: Dharam J. Kumbhani
Gabriel Steg
Christopher P. Cannon
Kim A. Eagle
Sidney C. Smith
Shinya Goto
E. Magnus Ohman
Yedid Elbez
Piyamitr Sritara
Iris Baumgartner
Subhash Banerjee
Mark A. Creager
Deepak L. Bhatt
UT Southwestern Medical Center
Universite Paris 7- Denis Diderot
Hopital Bichat-Claude-Bernard AP-HP
Royal Brompton Hospital
Harvard Medical School
TIMI Study Group
University of Michigan, Ann Arbor
The University of North Carolina at Chapel Hill
Tokai University School of Medicine
Duke University
Mahidol University
Swiss Cardiovascular Center, University Hospital Bern
VA Medical Center
Keywords: Medicine
Issue Date: 1-Jan-2014
Citation: European Heart Journal. Vol.35, No.41 (2014), 2864-2872
Abstract: © 2014 The Author. Aims Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry. Methods Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users. Results A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01). Conclusion Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.
ISSN: 15229645
Appears in Collections:Scopus 2011-2015

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