Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia
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 associate...
Gespeichert in:
| Veröffentlicht in: | Journal of the American College of Cardiology 2014-02, Vol.63 (7), p.682-690 |
|---|---|
| Hauptverfasser: | , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 690 |
|---|---|
| container_issue | 7 |
| container_start_page | 682 |
| container_title | Journal of the American College of Cardiology |
| container_volume | 63 |
| creator | Westin, Gregory G., AB, MAS Armstrong, Ehrin J., MD, MSc, MAS Bang, Heejung, PhD Yeo, Khung-Keong, MBBS Anderson, David, BA Dawson, David L., MD Pevec, William C., MD Amsterdam, Ezra A., MD Laird, John R., MD |
| description | 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 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. |
| doi_str_mv | 10.1016/j.jacc.2013.09.073 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1501376061</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0735109713062098</els_id><sourcerecordid>1501376061</sourcerecordid><originalsourceid>FETCH-LOGICAL-c513t-aaf1e8fad6b4013ea17e1746e06ae6730a3d85457d6b64ccac7081e66fb9f6273</originalsourceid><addsrcrecordid>eNp9kt-K1DAUxoMo7uzqC3ghARH2YjsmTZu2sAjjsKsLMyiM4mU4k56yqf0zJmllXsZnNZ0ZXdgLr0KS3_fl5HyHkFeczTnj8l09r0Hrecy4mLNizjLxhMx4muaRSIvsKZmFkzTirMjOyLlzNWNM5rx4Ts7iRPC04HxGfi-c67UBb_qOfkD_C7GjGx_2HV1jafThxlHoSrrurYfG-P0VXUPdW7ooR7QO6RJsafoRnB4asPRmxM5fHSSLdjf4g0V0axHpZrCjGaGhwf5LOA-go9-Nv6dLa3x4raEr027pndP32Bp4QZ5V0Dh8eVovyLfbm6_LT9Hq88e75WIV6ZQLHwFUHPMKSrlNQjcQeIY8SyQyCSgzwUCUeZqkWQBkojXojOUcpay2RSXjTFyQy6PvzvY_B3RetcZpbBrosB-c4mmwzSSTPKBvHqF1P9guVKe4TFIRM5GLQMVHStveOYuV2lnTgt0rztSUnqrVlJ6a0lOsUCGrIHp9sh62LZb_JH_jCsDbExB6DU1lodPGPXB5XMhYTNz1kcPQs9GgVU6HXusQqEXtVdmb_9fx_pFcN6ab0vmBe3QP_1UuVkxtpjmbxowLJmNW5OIPagzOSA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1645320383</pqid></control><display><type>article</type><title>Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Westin, Gregory G., AB, MAS ; Armstrong, Ehrin J., MD, MSc, MAS ; Bang, Heejung, PhD ; Yeo, Khung-Keong, MBBS ; Anderson, David, BA ; Dawson, David L., MD ; Pevec, William C., MD ; Amsterdam, Ezra A., MD ; Laird, John R., MD</creator><creatorcontrib>Westin, Gregory G., AB, MAS ; Armstrong, Ehrin J., MD, MSc, MAS ; Bang, Heejung, PhD ; Yeo, Khung-Keong, MBBS ; Anderson, David, BA ; Dawson, David L., MD ; Pevec, William C., MD ; Amsterdam, Ezra A., MD ; Laird, John R., MD</creatorcontrib><description>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.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2013.09.073</identifier><identifier>PMID: 24315911</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Amputation ; Amputation, Surgical - mortality ; Amputation, Surgical - trends ; Angiography ; Angioplasty ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology ; Cardiology. Vascular system ; Cardiovascular ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - drug therapy ; Cardiovascular Diseases - mortality ; Cardiovascular system ; Cerebral infarction ; Cerebrovascular system ; Confidence intervals ; Coronary artery ; Coronary artery disease ; Critical Illness - mortality ; Diabetes mellitus ; Diagnostic systems ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Extremities - blood supply ; Extremities - surgery ; Female ; Follow-Up Studies ; Health risk assessment ; Heart ; Heart diseases ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use ; Hypertension ; Internal Medicine ; Ischemia ; Ischemia - drug therapy ; Ischemia - mortality ; Ischemia - surgery ; Limb Salvage - mortality ; Limb Salvage - trends ; lipids and lipoproteins ; Low density lipoprotein ; major adverse cardiac event(s) ; Male ; Medical imaging ; Medical sciences ; Middle Aged ; Mortality ; Myocardial infarction ; Orthopedic surgery ; Patients ; peripheral artery disease ; Registries ; Retrospective Studies ; secondary prevention ; statin therapy ; Statins ; Statistical analysis ; Stroke ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival ; Survival Rate - trends ; Treatment Outcome ; Ulcers ; Weighting</subject><ispartof>Journal of the American College of Cardiology, 2014-02, Vol.63 (7), p.682-690</ispartof><rights>American College of Cardiology Foundation</rights><rights>2014 American College of Cardiology Foundation</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 25, 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c513t-aaf1e8fad6b4013ea17e1746e06ae6730a3d85457d6b64ccac7081e66fb9f6273</citedby><cites>FETCH-LOGICAL-c513t-aaf1e8fad6b4013ea17e1746e06ae6730a3d85457d6b64ccac7081e66fb9f6273</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109713062098$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28296231$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24315911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Westin, Gregory G., AB, MAS</creatorcontrib><creatorcontrib>Armstrong, Ehrin J., MD, MSc, MAS</creatorcontrib><creatorcontrib>Bang, Heejung, PhD</creatorcontrib><creatorcontrib>Yeo, Khung-Keong, MBBS</creatorcontrib><creatorcontrib>Anderson, David, BA</creatorcontrib><creatorcontrib>Dawson, David L., MD</creatorcontrib><creatorcontrib>Pevec, William C., MD</creatorcontrib><creatorcontrib>Amsterdam, Ezra A., MD</creatorcontrib><creatorcontrib>Laird, John R., MD</creatorcontrib><title>Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>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.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Amputation</subject><subject>Amputation, Surgical - mortality</subject><subject>Amputation, Surgical - trends</subject><subject>Angiography</subject><subject>Angioplasty</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular diseases</subject><subject>Cardiovascular Diseases - drug therapy</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular system</subject><subject>Cerebral infarction</subject><subject>Cerebrovascular system</subject><subject>Confidence intervals</subject><subject>Coronary artery</subject><subject>Coronary artery disease</subject><subject>Critical Illness - mortality</subject><subject>Diabetes mellitus</subject><subject>Diagnostic systems</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Extremities - blood supply</subject><subject>Extremities - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health risk assessment</subject><subject>Heart</subject><subject>Heart diseases</subject><subject>Humans</subject><subject>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</subject><subject>Hypertension</subject><subject>Internal Medicine</subject><subject>Ischemia</subject><subject>Ischemia - drug therapy</subject><subject>Ischemia - mortality</subject><subject>Ischemia - surgery</subject><subject>Limb Salvage - mortality</subject><subject>Limb Salvage - trends</subject><subject>lipids and lipoproteins</subject><subject>Low density lipoprotein</subject><subject>major adverse cardiac event(s)</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Orthopedic surgery</subject><subject>Patients</subject><subject>peripheral artery disease</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>secondary prevention</subject><subject>statin therapy</subject><subject>Statins</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival</subject><subject>Survival Rate - trends</subject><subject>Treatment Outcome</subject><subject>Ulcers</subject><subject>Weighting</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kt-K1DAUxoMo7uzqC3ghARH2YjsmTZu2sAjjsKsLMyiM4mU4k56yqf0zJmllXsZnNZ0ZXdgLr0KS3_fl5HyHkFeczTnj8l09r0Hrecy4mLNizjLxhMx4muaRSIvsKZmFkzTirMjOyLlzNWNM5rx4Ts7iRPC04HxGfi-c67UBb_qOfkD_C7GjGx_2HV1jafThxlHoSrrurYfG-P0VXUPdW7ooR7QO6RJsafoRnB4asPRmxM5fHSSLdjf4g0V0axHpZrCjGaGhwf5LOA-go9-Nv6dLa3x4raEr027pndP32Bp4QZ5V0Dh8eVovyLfbm6_LT9Hq88e75WIV6ZQLHwFUHPMKSrlNQjcQeIY8SyQyCSgzwUCUeZqkWQBkojXojOUcpay2RSXjTFyQy6PvzvY_B3RetcZpbBrosB-c4mmwzSSTPKBvHqF1P9guVKe4TFIRM5GLQMVHStveOYuV2lnTgt0rztSUnqrVlJ6a0lOsUCGrIHp9sh62LZb_JH_jCsDbExB6DU1lodPGPXB5XMhYTNz1kcPQs9GgVU6HXusQqEXtVdmb_9fx_pFcN6ab0vmBe3QP_1UuVkxtpjmbxowLJmNW5OIPagzOSA</recordid><startdate>20140225</startdate><enddate>20140225</enddate><creator>Westin, Gregory G., AB, MAS</creator><creator>Armstrong, Ehrin J., MD, MSc, MAS</creator><creator>Bang, Heejung, PhD</creator><creator>Yeo, Khung-Keong, MBBS</creator><creator>Anderson, David, BA</creator><creator>Dawson, David L., MD</creator><creator>Pevec, William C., MD</creator><creator>Amsterdam, Ezra A., MD</creator><creator>Laird, John R., MD</creator><general>Elsevier Inc</general><general>Elsevier</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TK</scope><scope>H94</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope></search><sort><creationdate>20140225</creationdate><title>Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia</title><author>Westin, Gregory G., AB, MAS ; Armstrong, Ehrin J., MD, MSc, MAS ; Bang, Heejung, PhD ; Yeo, Khung-Keong, MBBS ; Anderson, David, BA ; Dawson, David L., MD ; Pevec, William C., MD ; Amsterdam, Ezra A., MD ; Laird, John R., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c513t-aaf1e8fad6b4013ea17e1746e06ae6730a3d85457d6b64ccac7081e66fb9f6273</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Amputation</topic><topic>Amputation, Surgical - mortality</topic><topic>Amputation, Surgical - trends</topic><topic>Angiography</topic><topic>Angioplasty</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cardiovascular Diseases - drug therapy</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular system</topic><topic>Cerebral infarction</topic><topic>Cerebrovascular system</topic><topic>Confidence intervals</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>Critical Illness - mortality</topic><topic>Diabetes mellitus</topic><topic>Diagnostic systems</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Extremities - blood supply</topic><topic>Extremities - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Heart diseases</topic><topic>Humans</topic><topic>Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use</topic><topic>Hypertension</topic><topic>Internal Medicine</topic><topic>Ischemia</topic><topic>Ischemia - drug therapy</topic><topic>Ischemia - mortality</topic><topic>Ischemia - surgery</topic><topic>Limb Salvage - mortality</topic><topic>Limb Salvage - trends</topic><topic>lipids and lipoproteins</topic><topic>Low density lipoprotein</topic><topic>major adverse cardiac event(s)</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Myocardial infarction</topic><topic>Orthopedic surgery</topic><topic>Patients</topic><topic>peripheral artery disease</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>secondary prevention</topic><topic>statin therapy</topic><topic>Statins</topic><topic>Statistical analysis</topic><topic>Stroke</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival</topic><topic>Survival Rate - trends</topic><topic>Treatment Outcome</topic><topic>Ulcers</topic><topic>Weighting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Westin, Gregory G., AB, MAS</creatorcontrib><creatorcontrib>Armstrong, Ehrin J., MD, MSc, MAS</creatorcontrib><creatorcontrib>Bang, Heejung, PhD</creatorcontrib><creatorcontrib>Yeo, Khung-Keong, MBBS</creatorcontrib><creatorcontrib>Anderson, David, BA</creatorcontrib><creatorcontrib>Dawson, David L., MD</creatorcontrib><creatorcontrib>Pevec, William C., MD</creatorcontrib><creatorcontrib>Amsterdam, Ezra A., MD</creatorcontrib><creatorcontrib>Laird, John R., MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Westin, Gregory G., AB, MAS</au><au>Armstrong, Ehrin J., MD, MSc, MAS</au><au>Bang, Heejung, PhD</au><au>Yeo, Khung-Keong, MBBS</au><au>Anderson, David, BA</au><au>Dawson, David L., MD</au><au>Pevec, William C., MD</au><au>Amsterdam, Ezra A., MD</au><au>Laird, John R., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>2014-02-25</date><risdate>2014</risdate><volume>63</volume><issue>7</issue><spage>682</spage><epage>690</epage><pages>682-690</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><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.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>24315911</pmid><doi>10.1016/j.jacc.2013.09.073</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0735-1097 |
| ispartof | Journal of the American College of Cardiology, 2014-02, Vol.63 (7), p.682-690 |
| issn | 0735-1097 1558-3597 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1501376061 |
| source | MEDLINE; Elsevier ScienceDirect Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Amputation Amputation, Surgical - mortality Amputation, Surgical - trends Angiography Angioplasty Biological and medical sciences Blood and lymphatic vessels Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - drug therapy Cardiovascular Diseases - mortality Cardiovascular system Cerebral infarction Cerebrovascular system Confidence intervals Coronary artery Coronary artery disease Critical Illness - mortality Diabetes mellitus Diagnostic systems Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Extremities - blood supply Extremities - surgery Female Follow-Up Studies Health risk assessment Heart Heart diseases Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use Hypertension Internal Medicine Ischemia Ischemia - drug therapy Ischemia - mortality Ischemia - surgery Limb Salvage - mortality Limb Salvage - trends lipids and lipoproteins Low density lipoprotein major adverse cardiac event(s) Male Medical imaging Medical sciences Middle Aged Mortality Myocardial infarction Orthopedic surgery Patients peripheral artery disease Registries Retrospective Studies secondary prevention statin therapy Statins Statistical analysis Stroke Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Survival Rate - trends Treatment Outcome Ulcers Weighting |
| title | Association Between Statin Medications and Mortality, Major Adverse Cardiovascular Event, and Amputation-Free Survival in Patients With Critical Limb Ischemia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-02T22%3A58%3A08IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Association%20Between%20Statin%20Medications%20and%20Mortality,%20Major%20Adverse%20Cardiovascular%20Event,%20and%20Amputation-Free%20Survival%20in%20Patients%20With%20Critical%20Limb%20Ischemia&rft.jtitle=Journal%20of%20the%20American%20College%20of%20Cardiology&rft.au=Westin,%20Gregory%20G.,%20AB,%20MAS&rft.date=2014-02-25&rft.volume=63&rft.issue=7&rft.spage=682&rft.epage=690&rft.pages=682-690&rft.issn=0735-1097&rft.eissn=1558-3597&rft.coden=JACCDI&rft_id=info:doi/10.1016/j.jacc.2013.09.073&rft_dat=%3Cproquest_cross%3E1501376061%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1645320383&rft_id=info:pmid/24315911&rft_els_id=S0735109713062098&rfr_iscdi=true |