Lipid-lowering therapy in patients with peripheral arterial disease: are guidelines being met?
OBJECTIVE
To determine the proportion of patients with lower extremity peripheral arterial disease (PAD) who reach recommended low-density lipoprotein cholesterol (LDL-C) levels (<100 mg/dL) and to identify the patient characteristics that are independently associated with attaining the LDL-C goal (<100 mg/dL).


METHODS
Eligible patients were identified from a roster of patients who had undergone testing at a nonvascular laboratory between September 1, 2001, and January 31, 2002, and were found to have evidence of PAD, defined as an ankle-brachial index of 0.9 or less. We thoroughly reviewed patients' electronic medical records. Backward elimination multivariate logistic regression modeling was used to Identify factors associated with reaching the goal LDL-C level.


RESULTS
Among 143 patients with PAD, 105 (73%) met the goal LDL-C level. Lipid-lowering therapy was prescribed for 109 (76%). Lower diastolic blood pressure and lower weight were independently associated with an LDL-C level of less than 100 mg/dL.


CONCLUSIONS
We found higher rates of lipid-lowering therapy in patients with PAD than reported previously. Patients with diabetes mellitus or coronary artery disease were not more likely to meet the goal LDL-C level than those without these comorbidities. Clinical practice may be catching up to clinical guidelines.
Federman
Daniel G
DG
Department of Internal Medicine, West Haven Veterans Affairs Medical Center, West Haven, Conn, USA. daniel.federman@med.va.gov
Ranani
Dana C
DC
Kirsner
Robert S
RS
Bravata
Dawn M
DM
D000368:Aged; D000369:Aged, 80 and over; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D001161:Arteriosclerosis / Q000097:blood / Q000188:drug therapy*; D008078:Cholesterol, LDL / Q000097:blood; D019983:Guideline Adherence; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000188:drug therapy*; D017410:Practice Guidelines as Topic
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL