J. Dopheide1, J. Veit1, H. Ramadani1, L. Adam1, L. Papac1, M. Schindewolf1, A. Vonbank2, I. Baumgartner1, H. Drexel1 (1Bern ; 2Feldkirch AT)
Background: Statins reduce cardiovascular morbidity and mortality, but adherence is suboptimal. We hypothesized that adherence to statins determines survival in patients with peripheral artery disease (PAD).
Methods and Results: Single center observational study with 691 symptomatic PAD patients admitted to a tertiary university center between 2010 and 2017. Mortality was evaluated over a mean follow-up of 50±26 months. Statin adherence and LDL-C target attainment was related to total mortality.
Initially, 73% of the patients were on statins with an increase in statin use to 81% (p<0.0001) at follow-up: Statin dosage, normalized to simvastatin 40 mg, increased from 50 to 58 mg/day (p<0.0001), paralleled by mean decrease of LDL-C from 97 to 82 mg/dL (p<0.0001). Proportion of patients on a high intensity statin treatment increased over time from 38 to 62% (p<0.0001).
Patients never receiving statins had a higher mortality rate (34%) as compared to patients being on statins (20%) or having newly received a statin (15%; p < 0.01). Moreover, patients on intensified statin medication had the lowest mortality (10%), whereas patients who terminated statin medication or reduced the statin dosage had a higher mortality rate (33% and 43%, respectively; p < 0.05).
Conclusion: Statin treatment, particularly high-intensity therapy, reduces mortality in symptomatic PAD. Patients benefit even from de novo statin therapy, whereas dose reduction or statin discontinuation have deleterious effects. A strategy of intensive and sustained statin therapy is worthwhile.