Secondary Prevention in Lower Extremity Artery Disease Patients: Lipid-Lowering Therapy and Long-Term Guideline...

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Lipidology

Background:

• Lower extremity artery disease (LEAD) significantly increases cardiovascular morbidity and mortality in elderly patients.
• Current guidelines mandate aggressive lipid-lowering therapy, yet a minority achieve target low-density lipoprotein cholesterol (LDL-C) levels (< 55 mg/dL).

Purpose of the Study:

• To evaluate the adherence to lipid-lowering guideline recommendations in LEAD patients with elevated LDL-C (> 100 mg/dL).
• To assess treatment adjustments and achievement of LDL-C targets during follow-up.
• To analyze the impact of pharmacological and lifestyle interventions on cardiovascular event progression.

Main Methods:

• Retrospective analysis of 400 LEAD patients with LDL-C > 100 mg/dL.
• Assessment of statin and ezetimibe prescription rates and adherence.
• Evaluation of LDL-C goal attainment and cardiovascular event rates (revascularization, coronary artery disease, cerebrovascular disease, mortality).

Main Results:

• 93% of patients received statins, with 77% on high-intensity statins, yet only 18% achieved LDL-C < 55 mg/dL.
• Ezetimibe was used in 21% of patients; combination therapy significantly improved LDL-C goal attainment.
• Cardiovascular events included recurrent revascularization (28%), disease progression (14%), and mortality (7%).
• Only 18% of patients received lifestyle modification recommendations.

Conclusions:

• Current lipid-lowering strategies, even with high-intensity statins and ezetimibe, are insufficient to prevent cardiovascular events in most LEAD patients.
• Adherence to lifestyle modification recommendations is critically low and requires improvement.
• Integrated pharmacological and behavioral approaches are essential to enhance clinical outcomes and survival in LEAD.