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Statins for Prevention of Cardiovascular Events in a Low-Risk Population With Low Ankle Brachial Index
Rafel Ramos1, Maria García-Gil2, Marc Comas-Cufí3
1Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Catalunya, Spain; ISV Research Group, Research Unit in Primary Care, Primary Care Services, Girona, Catalan Institute of Health (ICS), Catalunya, Spain; Biomedical Research Institute, Girona (IdIBGi), ICS, Catalunya, Spain; TransLab Research Group, Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.
Insights
Statin therapy significantly reduced major adverse cardiovascular events (MACE) and mortality in patients with asymptomatic peripheral arterial disease. This risk reduction was observed even in individuals with low cardiovascular disease risk.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
- Public Health
Background:
- Limited evidence exists on risk reduction interventions for asymptomatic peripheral arterial disease (PAD).
- Asymptomatic PAD patients often have low calculated cardiovascular disease (CVD) risk, complicating treatment decisions.
Purpose of the Study:
- To evaluate the association between statin therapy and major adverse cardiovascular events (MACE) and mortality in patients with asymptomatic PAD.
- To determine if statins offer cardiovascular benefits in a population not typically targeted for aggressive risk reduction.
Main Methods:
- A cohort of 5,480 patients (age 35-85) with asymptomatic PAD (ankle-brachial index ≤0.95) was identified from primary care records (2006-2013).
- Patients were categorized as statin new-users or nonusers and matched 1:1 using propensity scores.
- Conditional Cox proportional hazards models analyzed the incidence of MACE (myocardial infarction, cardiac revascularization, ischemic stroke) and all-cause mortality.
Main Results:
- Statin new-users showed a reduced incidence of MACE (19.7 vs. 24.7 per 1,000 person-years) and all-cause mortality (24.8 vs. 30.3 per 1,000 person-years).
- Hazards ratios were 0.80 for MACE and 0.81 for overall mortality, indicating significant risk reduction.
- The 1-year number needed to treat was 200 for MACE and 239 for all-cause mortality.
Conclusions:
- Statin therapy is associated with reduced MACE and all-cause mortality in patients with asymptomatic PAD, irrespective of their low calculated CVD risk.
- The observed absolute risk reduction is comparable to that seen in secondary cardiovascular prevention settings.
- These findings support the consideration of statin therapy for risk reduction in asymptomatic PAD patients.
Background:
Evidence is lacking about the effectiveness of risk reduction interventions in patients with asymptomatic peripheral arterial disease.
Objectives:
This study aimed to assess whether statin therapy was associated with a reduction in major adverse cardiovascular events (MACE) and mortality in this population.
Methods:
Data were obtained from 2006 through 2013 from the Catalan primary care system's clinical records database (SIDIAP). Patients age 35 to 85 years with an ankle-brachial index ≤0.95 and without clinically recognized cardiovascular disease (CVD) were included. Participants were categorized as statins nonusers or new-users (first prescription or represcribed after at least 6 months) and matched 1:1 by inclusion date and propensity score for statin treatment. Conditional Cox proportional hazards modeling was used to compare the groups for the incidence of MACE (myocardial infarction, cardiac revascularization, and ischemic stroke) and all-cause mortality.
Results:
The matched-pair cohort included 5,480 patients (mean age 67 years; 44% women) treated/nontreated with statins. The 10-year coronary heart disease risk was low (median: 6.9%). Median follow-up was 3.6 years. Incidence of MACE was 19.7 and 24.7 events per 1,000 person-years in statin new-users and nonusers, respectively. Total mortality rates also differed: 24.8 versus 30.3 per 1,000 person-years, respectively. Hazards ratios were 0.80 for MACE and 0.81 for overall mortality. The 1-year number needed to treat was 200 for MACE and 239 for all-cause mortality.
Conclusions:
Statin therapy was associated with a reduction in MACE and all-cause mortality among participants without clinical CVD but with asymptomatic peripheral arterial disease, regardless of its low CVD risk. The absolute reduction was comparable to that achieved in secondary prevention.
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