title: Comparison of effects of statin use on mortality in patients with peripheral arterial disease with versus without elevated C-reactive protein and d-dimer levels.
abstract: We determined whether statin use was associated with lower all-cause and cardiovascular disease (CVD) mortality in 579 participants with lower extremity peripheral arterial disease (PAD) according to the presence and absence of elevated C-reactive protein (CRP) and D-dimer levels. Statin use was determined at baseline and at each annual visit. The CRP and D-dimer levels were measured at baseline. The mean follow-up was 3.7 years. The analyses were adjusted for age, gender, race, co-morbidities, ankle brachial index, cholesterol, and other confounders. Of the 579 participants, 242 (42%) were taking a statin at baseline and 129 (22%) died during follow-up. Statin use was associated with lower all-cause mortality (hazard ratio 0.51, 95% confidence interval [CI] 0.30 to 0.86, p = 0.012) and CVD mortality (hazard ratio 0.36, 95% CI 0.14 to 0.89, p = 0.027) compared to statin nonuse. No statistically significant interaction was found for the baseline CRP or D-dimer level with the association of statin use and mortality. However, statin therapy was associated with significantly lower all-cause and total mortality only among participants with baseline CRP values greater than the median and not among those with CRP values less than the median (hazard ratio 0.44, 95% CI 0.23 to 0.88 vs hazard ratio 0.73, 95% CI 0.31 to 1.75 for all-cause mortality and hazard ratio 0.20, 95% CI 0.063 to 0.65 vs hazard ratio 0.59, 95% CI 0.093 to 3.79 for CVD mortality). In conclusion, among those with PAD, statin use was associated with lower all-cause and CVD mortality compared to no statin use. The favorable association of statin use with mortality was not influenced significantly by the baseline CRP or D-dimer level.
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Himabindu
authors.initials: H
authors.lastname: Vidula
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.forename: Kiang
authors.initials: K
authors.lastname: Liu
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.forename: Jack M
authors.initials: JM
authors.lastname: Guralnik
authors.forename: David
authors.initials: D
authors.lastname: Green
authors.forename: Paul
authors.initials: P
authors.lastname: Ridker
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000188:drug therapy / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016909:Tibial Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein
references.citation: Ann Clin Biochem. 1998 Nov;35 ( Pt 6):745-53
references.pmid: 9838988
references.citation: N Engl J Med. 2008 Nov 20;359(21):2195-207
references.pmid: 18997196
references.citation: J Am Coll Cardiol. 2004 Aug 4;44(3):618-23
references.pmid: 15358030
references.citation: Circulation. 1994 Oct;90(4):2126-46
references.pmid: 7718033
references.citation: Circulation. 1995 Mar 1;91(5):1472-9
references.pmid: 7867189
references.citation: Am J Cardiol. 2001 Jul 1;88(1):A7-8, 89-92
references.pmid: 11423069
references.citation: Circulation. 1993 Sep;88(3):837-45
references.pmid: 8353913
references.citation: JAMA. 2004 Jul 28;292(4):453-61
references.pmid: 15280343
references.citation: Clin Chem. 1974 Apr;20(4):470-5
references.pmid: 4818200
references.citation: Am J Cardiol. 2003 Jul 15;92(2):194-9
references.pmid: 12860223
references.citation: J Am Geriatr Soc. 2007 Mar;55(3):400-6
references.pmid: 17341243
references.citation: Circulation. 2002 Mar 5;105(9):1135-43
references.pmid: 11877368
references.citation: Circulation. 1995 Sep 1;92(5):1355-74
references.pmid: 7648691
references.citation: Ann Intern Med. 2008 Jan 15;148(2):85-93
references.pmid: 18195333
references.citation: J Endovasc Ther. 2002 Feb;9(1):59-66
references.pmid: 11958327
references.citation: Clin Chem. 1995 May;41(5):717-23
references.pmid: 7729051
references.citation: Am Heart J. 2005 Aug;150(2):276-81
references.pmid: 16086930
references.citation: Kidney Int. 2003 Jan;63(1):12-23
references.pmid: 12472764
references.citation: Eur Heart J. 2004 May;25(9):742-8
references.pmid: 15120884
references.citation: Arterioscler Thromb Vasc Biol. 2001 Nov;21(11):1712-9
references.pmid: 11701455
references.citation: J Vasc Surg. 2000 Dec;32(6):1164-71
references.pmid: 11107089