title: Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia.
abstract: OBJECTIVE
  The aim of this study was to determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients.
  
  
  BACKGROUND
  CLI is an advanced form of peripheral arterial disease associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain.
  
  
  METHODS
  We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins.
  
  
  RESULTS
  Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl vs. 96 ± 40 mg/dl, p < 0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all p values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL.
  
  
  CONCLUSIONS
  Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.
authors: School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
authors: Gregory G
authors: GG
authors: Westin
authors: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
authors: Ehrin J
authors: EJ
authors: Armstrong
authors: Division of Biostatistics, Department of Public Health Sciences, UC Davis, Davis, California.
authors: Heejung
authors: H
authors: Bang
authors: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
authors: Khung-Keong
authors: KK
authors: Yeo
authors: School of Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
authors: David
authors: D
authors: Anderson
authors: Division of Vascular and Endovascular Surgery, the Vascular Center, Sacramento, California.
authors: David L
authors: DL
authors: Dawson
authors: Division of Vascular and Endovascular Surgery, the Vascular Center, Sacramento, California.
authors: William C
authors: WC
authors: Pevec
authors: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California.
authors: Ezra A
authors: EA
authors: Amsterdam
authors: Division of Cardiovascular Medicine and the Vascular Center, UC Davis Medical Center, Sacramento, California. Electronic address: john.laird@ucdmc.ucdavis.edu.
authors: John R
authors: JR
authors: Laird
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000671:Amputation, Surgical / Q000401:mortality* / Q000639:trends; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality*; D016638:Critical Illness / Q000401:mortality*; D005121:Extremities / Q000098:blood supply* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007511:Ischemia / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D023821:Limb Salvage / Q000401:mortality* / Q000639:trends; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: lipids and lipoproteins; major adverse cardiac event(s); peripheral artery disease; secondary prevention; statin therapy