Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease
Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in peripheral artery disease (PAD). Lipid-lowering therapies (LLT) that reduce LDL-C decrease this risk. The authors examined LLT use and...
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| Veröffentlicht in: | Journal of the American College of Cardiology 2021-06, Vol.77 (24), p.3016-3027 |
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| container_title | Journal of the American College of Cardiology |
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| creator | Hess, Connie N. Cannon, Christopher P. Beckman, Joshua A. Goodney, Philip P. Patel, Manesh R. Hiatt, William R. Mues, Katherine E. Orroth, Kate K. Shannon, Erin Bonaca, Marc P. |
| description | Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in peripheral artery disease (PAD). Lipid-lowering therapies (LLT) that reduce LDL-C decrease this risk.
The authors examined LLT use and actual achieved LDL-C in PAD.
PAD patients in MarketScan from 2014 to 2018 were identified. Outcomes included LLT use, defined as high-intensity (HI) (high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor), low-intensity (any other lipid regimen), or no therapy, and follow-up LDL-C. Factors associated with LDL-C |
| doi_str_mv | 10.1016/j.jacc.2021.04.060 |
| format | Article |
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The authors examined LLT use and actual achieved LDL-C in PAD.
PAD patients in MarketScan from 2014 to 2018 were identified. Outcomes included LLT use, defined as high-intensity (HI) (high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor), low-intensity (any other lipid regimen), or no therapy, and follow-up LDL-C. Factors associated with LDL-C <70 mg/dl were identified with multivariable logistic regression.
Among 250,103 PAD patients, 20.5% and 39.5% were treated at baseline with HI and low-intensity LLT, respectively; 40.0% were on no LLT. Over a 15-month median follow-up period, HI LLT use increased by 1.5%. Among 18,747 patients with LDL-C data, at baseline, 25.1% were on HI LLT, median LDL-C was 91 mg/dl, and 24.5% had LDL-C <70 mg/dl. Within the HI LLT subgroup, median LDL-C was 81 mg/dl, and 64% had LDL-C ≥70 mg/dl. At follow-up, HI LLT use increased by 3.7%, median LDL-C decreased by 4.0 mg/dl, and an additional 4.1% of patients had LDL-C <70 mg/dl. HI LLT use was greater after follow-up MACE (55.0%) or MALE (41.0%) versus no ischemic event (26.1%). After MACE or MALE, LDL-C was <70 mg/dl in 41.5% and 36.1% of patients, respectively, versus 27.1% in those without an event. Factors associated with follow-up LDL-C <70 mg/dl included smoking, hypertension, diabetes, prior lower extremity revascularization, and prior myocardial infarction but not prior acute or critical limb ischemia.
In PAD, LLT use is suboptimal, LDL-C remains elevated, and LLT intensity is a poor surrogate for achieved LDL-C. Less aggressive lipid management was observed in PAD versus cardiovascular disease, highlighting missed opportunities for implementation of proven therapies in PAD.
[Display omitted]</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2021.04.060</identifier><language>eng</language><publisher>Elsevier Inc</publisher><subject>lipid management ; outcomes ; peripheral artery disease</subject><ispartof>Journal of the American College of Cardiology, 2021-06, Vol.77 (24), p.3016-3027</ispartof><rights>2021 American College of Cardiology Foundation</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c377t-49db224fba2a03392896e7874095bb63434ca6463ef80361f9614b1c1f17262a3</citedby><cites>FETCH-LOGICAL-c377t-49db224fba2a03392896e7874095bb63434ca6463ef80361f9614b1c1f17262a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jacc.2021.04.060$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids></links><search><creatorcontrib>Hess, Connie N.</creatorcontrib><creatorcontrib>Cannon, Christopher P.</creatorcontrib><creatorcontrib>Beckman, Joshua A.</creatorcontrib><creatorcontrib>Goodney, Philip P.</creatorcontrib><creatorcontrib>Patel, Manesh R.</creatorcontrib><creatorcontrib>Hiatt, William R.</creatorcontrib><creatorcontrib>Mues, Katherine E.</creatorcontrib><creatorcontrib>Orroth, Kate K.</creatorcontrib><creatorcontrib>Shannon, Erin</creatorcontrib><creatorcontrib>Bonaca, Marc P.</creatorcontrib><title>Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease</title><title>Journal of the American College of Cardiology</title><description>Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in peripheral artery disease (PAD). Lipid-lowering therapies (LLT) that reduce LDL-C decrease this risk.
The authors examined LLT use and actual achieved LDL-C in PAD.
PAD patients in MarketScan from 2014 to 2018 were identified. Outcomes included LLT use, defined as high-intensity (HI) (high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor), low-intensity (any other lipid regimen), or no therapy, and follow-up LDL-C. Factors associated with LDL-C <70 mg/dl were identified with multivariable logistic regression.
Among 250,103 PAD patients, 20.5% and 39.5% were treated at baseline with HI and low-intensity LLT, respectively; 40.0% were on no LLT. Over a 15-month median follow-up period, HI LLT use increased by 1.5%. Among 18,747 patients with LDL-C data, at baseline, 25.1% were on HI LLT, median LDL-C was 91 mg/dl, and 24.5% had LDL-C <70 mg/dl. Within the HI LLT subgroup, median LDL-C was 81 mg/dl, and 64% had LDL-C ≥70 mg/dl. At follow-up, HI LLT use increased by 3.7%, median LDL-C decreased by 4.0 mg/dl, and an additional 4.1% of patients had LDL-C <70 mg/dl. HI LLT use was greater after follow-up MACE (55.0%) or MALE (41.0%) versus no ischemic event (26.1%). After MACE or MALE, LDL-C was <70 mg/dl in 41.5% and 36.1% of patients, respectively, versus 27.1% in those without an event. Factors associated with follow-up LDL-C <70 mg/dl included smoking, hypertension, diabetes, prior lower extremity revascularization, and prior myocardial infarction but not prior acute or critical limb ischemia.
In PAD, LLT use is suboptimal, LDL-C remains elevated, and LLT intensity is a poor surrogate for achieved LDL-C. Less aggressive lipid management was observed in PAD versus cardiovascular disease, highlighting missed opportunities for implementation of proven therapies in PAD.
[Display omitted]</description><subject>lipid management</subject><subject>outcomes</subject><subject>peripheral artery disease</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp9kDtPwzAUhS0EEqXwB5g8siT4FSeWWEopD6mICoEYLce5po7SJNhppf57UpWZ6d7hfEc6H0LXlKSUUHlbp7WxNmWE0ZSIlEhygiY0y4qEZyo_RROS8yyhROXn6CLGmhAiC6om6H3hHNjB76CFGHHn8H3TdRVe-t5X-NW05hs20A7Yt3hlBj--EX_5YY1XEHy_hmAaPAsDhD1-8BFMhEt05kwT4ervTtHn4-Jj_pws355e5rNlYnmeD4lQVcmYcKVhhnCuWKEk5EUuiMrKUnLBhTVSSA6uIFxSpyQVJbXU0ZxJZvgU3Rx7-9D9bCEOeuOjhaYxLXTbqFk2VmRMyWyMsmPUhi7GAE73wW9M2GtK9EGgrvVBoD4I1EToUeAI3R0hGEfsPAQd7bjfQuXDqExXnf8P_wX3cngI</recordid><startdate>20210622</startdate><enddate>20210622</enddate><creator>Hess, Connie N.</creator><creator>Cannon, Christopher P.</creator><creator>Beckman, Joshua A.</creator><creator>Goodney, Philip P.</creator><creator>Patel, Manesh R.</creator><creator>Hiatt, William R.</creator><creator>Mues, Katherine E.</creator><creator>Orroth, Kate K.</creator><creator>Shannon, Erin</creator><creator>Bonaca, Marc P.</creator><general>Elsevier Inc</general><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20210622</creationdate><title>Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease</title><author>Hess, Connie N. ; Cannon, Christopher P. ; Beckman, Joshua A. ; Goodney, Philip P. ; Patel, Manesh R. ; Hiatt, William R. ; Mues, Katherine E. ; Orroth, Kate K. ; Shannon, Erin ; Bonaca, Marc P.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-49db224fba2a03392896e7874095bb63434ca6463ef80361f9614b1c1f17262a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>lipid management</topic><topic>outcomes</topic><topic>peripheral artery disease</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hess, Connie N.</creatorcontrib><creatorcontrib>Cannon, Christopher P.</creatorcontrib><creatorcontrib>Beckman, Joshua A.</creatorcontrib><creatorcontrib>Goodney, Philip P.</creatorcontrib><creatorcontrib>Patel, Manesh R.</creatorcontrib><creatorcontrib>Hiatt, William R.</creatorcontrib><creatorcontrib>Mues, Katherine E.</creatorcontrib><creatorcontrib>Orroth, Kate K.</creatorcontrib><creatorcontrib>Shannon, Erin</creatorcontrib><creatorcontrib>Bonaca, Marc P.</creatorcontrib><collection>CrossRef</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>Hess, Connie N.</au><au>Cannon, Christopher P.</au><au>Beckman, Joshua A.</au><au>Goodney, Philip P.</au><au>Patel, Manesh R.</au><au>Hiatt, William R.</au><au>Mues, Katherine E.</au><au>Orroth, Kate K.</au><au>Shannon, Erin</au><au>Bonaca, Marc P.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease</atitle><jtitle>Journal of the American College of Cardiology</jtitle><date>2021-06-22</date><risdate>2021</risdate><volume>77</volume><issue>24</issue><spage>3016</spage><epage>3027</epage><pages>3016-3027</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in peripheral artery disease (PAD). Lipid-lowering therapies (LLT) that reduce LDL-C decrease this risk.
The authors examined LLT use and actual achieved LDL-C in PAD.
PAD patients in MarketScan from 2014 to 2018 were identified. Outcomes included LLT use, defined as high-intensity (HI) (high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor), low-intensity (any other lipid regimen), or no therapy, and follow-up LDL-C. Factors associated with LDL-C <70 mg/dl were identified with multivariable logistic regression.
Among 250,103 PAD patients, 20.5% and 39.5% were treated at baseline with HI and low-intensity LLT, respectively; 40.0% were on no LLT. Over a 15-month median follow-up period, HI LLT use increased by 1.5%. Among 18,747 patients with LDL-C data, at baseline, 25.1% were on HI LLT, median LDL-C was 91 mg/dl, and 24.5% had LDL-C <70 mg/dl. Within the HI LLT subgroup, median LDL-C was 81 mg/dl, and 64% had LDL-C ≥70 mg/dl. At follow-up, HI LLT use increased by 3.7%, median LDL-C decreased by 4.0 mg/dl, and an additional 4.1% of patients had LDL-C <70 mg/dl. HI LLT use was greater after follow-up MACE (55.0%) or MALE (41.0%) versus no ischemic event (26.1%). After MACE or MALE, LDL-C was <70 mg/dl in 41.5% and 36.1% of patients, respectively, versus 27.1% in those without an event. Factors associated with follow-up LDL-C <70 mg/dl included smoking, hypertension, diabetes, prior lower extremity revascularization, and prior myocardial infarction but not prior acute or critical limb ischemia.
In PAD, LLT use is suboptimal, LDL-C remains elevated, and LLT intensity is a poor surrogate for achieved LDL-C. Less aggressive lipid management was observed in PAD versus cardiovascular disease, highlighting missed opportunities for implementation of proven therapies in PAD.
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| subjects | lipid management outcomes peripheral artery disease |
| title | Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease |
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