Long‐Term Effectiveness and Safety of Initiating Statin Therapy After Index Revascularization In Patients With Peripheral Arterial Occlusive Disease

• Published in: Journal of the American Heart Association Vol. 9; no. 22; p. e018338
• Main Authors: Peters, Frederik, Kuchenbecker, Jenny, Kreutzburg, Thea, Marschall, Ursula, Debus, E. Sebastian, Behrendt, Christian‐Alexander
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 17.11.2020; Wiley
• Subjects: Aged; Arterial Occlusive Diseases - drug therapy; Arterial Occlusive Diseases - mortality; Arterial Occlusive Diseases - surgery; Case-Control Studies; chronic limb‐threatening ischemia; Female; Fibrinolytic Agents - therapeutic use; Germany; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; intermittent claudication; Male; Middle Aged; Original Research; Peripheral Arterial Disease - drug therapy; Peripheral Arterial Disease - mortality; Peripheral Arterial Disease - surgery; peripheral arterial occlusive disease; Postoperative Complications - epidemiology; Propensity Score; statin therapy; statin‐induced myopathy; Survival Rate; Treatment Outcome; Germany; peripheral arterial occlusive disease; statin‐induced myopathy; chronic limb‐threatening ischemia; intermittent claudication; statin therapy
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.120.018338

Background An increasing number of patients with a peripheral arterial occlusive disease were put on statins during the past years. This study assessed whether statin therapy was effective and safe for these new users. Methods and Results Using health insurance claims data from Germany's second-largest insurance fund, BARMER, we identified patients with peripheral arterial occlusive disease who had index revascularization between 2008 and 2018 without prior statin therapy. We compared patients with and without statin therapy in addition to antithrombotics during the first quarter after discharge (new users versus nonusers). Outcomes were all-cause mortality, cardiovascular events, and incident major amputation for effectiveness and incident diabetes mellitus and incident myopathy for safety. Propensity score matching was used to balance the study groups. All analyses were stratified into patients with chronic limb-threatening ischemia and intermittent claudication. A total of 22 208 patients (mean age 71.1 years and 50.3% women) were included in the study. In 10 922 matched patients, statin initiation was associated with lower all-cause mortality (chronic limb-threatening ischemia: hazard ratio [HR], 0.75 [95% CI, 0.68-0.84]; intermittent claudication: HR, 0.80 [95% CI, 0.70-0.92]), lower risk of major amputation in patients with chronic limb-threatening ischemia (HR, 0.73; 95% CI, 0.58-0.93) and lower risk of cardiovascular events (hazard ratio, 0.80; 95% CI, 0.70-0.92) in patients with intermittent claudication during 5 years of follow-up. Safety outcomes did not differ among the study groups. Conclusions Initiating statin therapy in patients with peripheral arterial occlusive disease after index revascularization is efficient and safe with an effect size comparable to earlier studies. Awareness campaigns for evidence-based optimal pharmacological treatment among patients are recommended.