title: Effect of statin therapy on mortality in patients with peripheral arterial disease and comparison of those with versus without associated chronic obstructive pulmonary disease.
abstract: Chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) are both inflammatory conditions. Statins are commonly used in patients with PAD and have anti-inflammatory properties, which may have beneficial effects in patients with COPD. The relation between statin use and mortality was investigated in patients with PAD with and without COPD. From 1990 to 2006, we studied 3,371 vascular surgery patients. Statin use was noted at baseline and, if prescribed, converted to <25% (low dose) and > or =25% (intensified dose) of the maximum recommended therapeutic dose. The diagnosis of COPD was based on the Global Initiative for Chronic Obstructive Lung Disease guidelines using pulmonary function test. End points were short- (30-day) and long-term (10-year) mortality. A total of 330 patients with COPD (25%) used statins, and 480 patients (23%) without COPD. Statin use was independently associated with improved short- and long-term survival in patients with COPD (odds ratio 0.48, 95% confidence interval [CI] 0.23 to 1.00; hazard ratio 0.67, 95% CI 0.52 to 0.86, respectively). In patients without COPD, statins were also associated with improved short- and long-term survival (odds ratio 0.42, 95% CI 0.20 to 0.87; hazard ratio 0.76, 95% CI 0.60 to 0.95, respectively). In patients with COPD, only an intensified dose of statins was associated with improved short-term survival. However, for the long term, both low-dose and intensive statin therapy were beneficial. In conclusion, statin use was associated with improved short- and long-term survival in patients with PAD with and without COPD. Patients with COPD should be treated with an intensified dose of statins to achieve an optimal effect on both the short and long term.
authors.affiliation: Department of Anesthesiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Yvette R B M
authors.initials: YR
authors.lastname: van Gestel
authors.forename: Sanne E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Don D
authors.initials: DD
authors.lastname: Sin
authors.forename: Cihan
authors.initials: C
authors.lastname: Simsek
authors.forename: Gijs M J M
authors.initials: GM
authors.lastname: Welten
authors.forename: Olaf
authors.initials: O
authors.lastname: Schouten
authors.forename: Henk
authors.initials: H
authors.lastname: Stam
authors.forename: Frans W
authors.initials: FW
authors.lastname: Mertens
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D011184:Postoperative Period; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000401:mortality*; D012129:Respiratory Function Tests; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors