The quality and impact of risk factor control in patients with stable claudication presenting for peripheral vascular...

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Interventional Cardiology

Background:

• Peripheral arterial disease (PAD) signifies systemic atherosclerosis and predicts cardiovascular events.
• Medical therapy demonstrably reduces cardiovascular morbidity and mortality in PAD patients.
• The use and effect of recommended medical therapy in contemporary patients undergoing percutaneous interventions for lifestyle-limiting PAD remain unclear.

Purpose of the Study:

• To evaluate the utilization and impact of recommended medical therapy in patients with lifestyle-limiting PAD undergoing percutaneous intervention.
• To determine if pre-intervention medical therapy influences cardiovascular events and adverse peripheral vascular outcomes.

Main Methods:

• Analysis of 1357 peripheral vascular intervention encounters from the BMC2 PVI database (2007-2009) for claudication treatment.
• Assessment of pre-intervention medication use (aspirin, statin) and smoking status.
• Evaluation of 6-month adverse peripheral vascular outcomes (re-intervention, amputation, limb salvage).

Main Results:

• Before intervention, 85% used aspirin, 76% used statin, and 47% used both.
• No significant difference in cardiovascular events was observed between patients taking aspirin and statin versus those who were not.
• Patients receiving both aspirin and statin therapy pre-intervention had over a 50% lower odds of adverse peripheral vascular outcomes within 6 months (OR, 0.45; 95% CI, 0.29-0.71).

Conclusions:

• Fundamental medical therapies for lifestyle-limiting claudication are frequently underutilized before revascularization.
• Appropriate medical therapy administered prior to percutaneous revascularization is linked to a reduction in peripheral vascular events at 6 months.