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Adherence to Statin therapy drives survival of patients with symptomatic peripheral artery disease

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.

LDL-C and survival data regarding statin treatment.jpg
LDL-C and survival data regarding statin treatment.jpg
    
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            [titel] => Adherence to Statin therapy drives survival of patients with symptomatic peripheral artery disease

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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.

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CH-3010 Bern
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