Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease.

Abstract

BACKGROUND:

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.

OBJECTIVES:

The authors examined LLT use and actual achieved LDL-C in PAD.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Connie N Hess, Christopher P Cannon, Joshua A Beckman, Philip P Goodney, Manesh R Patel, William R Hiatt, Katherine E Mues, Kate K Orroth, Erin Shannon, Marc P Bonaca
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 77 Issue 24 Pg. 3016-3027 (06 22 2021) ISSN: 1558-3597 [Electronic] United States
• PMID: 34140105 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Anticholesteremic Agents
• Cholesterol, LDL
• Hypolipidemic Agents

Topics

• Adolescent
• Adult
• Aged
• Anticholesteremic Agents (therapeutic use)
• Cholesterol, LDL (antagonists & inhibitors, blood)
• Databases, Factual
• Disease Management
• Dyslipidemias (blood, drug therapy, epidemiology)
• Female
• Follow-Up Studies
• Humans
• Hypolipidemic Agents (therapeutic use)
• Male
• Middle Aged
• Peripheral Arterial Disease (blood, drug therapy, epidemiology)
• Treatment Outcome
• Young Adult