title: Statin therapy and long-term adverse limb outcomes in patients with peripheral artery disease: insights from the REACH registry.
abstract: OBJECTIVE
  Due to a high burden of systemic cardiovascular events, current guidelines recommend the use of statins in all patients with peripheral artery disease (PAD). We sought to study the impact of statin use on limb prognosis in patients with symptomatic PAD enrolled in the international REACH registry.
  
  
  METHODS
  Statin use was assessed at study enrolment, as well as a time-varying covariate. Rates of the primary adverse limb outcome (worsening claudication/new episode of critical limb ischaemia, new percutaneous/surgical revascularization, or amputation) at 4 years and the composite of cardiovascular death/myocardial infarction/stroke were compared among statin users vs. non-users.
  
  
  RESULTS
  A total of 5861 patients with symptomatic PAD were included. Statin use at baseline was 62.2%. Patients who were on statins had a significantly lower risk of the primary adverse limb outcome at 4 years when compared with those who were not taking statins [22.0 vs. 26.2%; hazard ratio (HR), 0.82; 95% confidence interval (CI), 0.72-0.92; P = 0.0013]. Results were similar when statin use was considered as a time-dependent variable (P = 0.018) and on propensity analysis (P < 0.0001). The composite of cardiovascular death/myocardial infarction/stroke was similarly reduced (HR, 0.83; 95% CI, 0.73-0.96; P = 0.01).
  
  
  CONCLUSIONS
  Among patients with PAD in the REACH registry, statin use was associated with an ∼18% lower rate of adverse limb outcomes, including worsening symptoms, peripheral revascularization, and ischaemic amputations. These findings suggest that statin therapy not only reduces the risk of adverse cardiovascular events, but also favourably affects limb prognosis in patients with PAD.
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA dharam@post.harvard.edu.
authors.forename: Dharam J
authors.initials: DJ
authors.lastname: Kumbhani
authors.affiliation: Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK.
authors.forename: Ph Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Cannon
authors.affiliation: University of Michigan Cardiovascular Center, Ann Arbor, MI, USA.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
authors.affiliation: Center for Cardiovascular Science and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Sidney C
authors.initials: SC
authors.lastname: Smith
authors.affiliation: Department of Medicine, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Goto
authors.affiliation: Division of Cardiology, Duke University, Durham, NC, USA.
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France INSERM U-1148, Paris, France Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Yedid
authors.initials: Y
authors.lastname: Elbez
authors.affiliation: Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Piyamitr
authors.initials: P
authors.lastname: Sritara
authors.affiliation: Swiss Cardiovascular Center Bern, University Hospital Bern, Switzerland.
authors.forename: Iris
authors.initials: I
authors.lastname: Baumgartner
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA.
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Creager
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA TIMI Study Group, Boston, MA, USA VA Boston Healthcare System, Boston, MA, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications; D018450:Disease Progression; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007383:Intermittent Claudication / Q000209:etiology / Q000517:prevention & control; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications / Q000188:drug therapy*; D010819:Physician's Role; D012042:Registries; D016896:Treatment Outcome
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Claudication; Morbidity; Peripheral vascular disease; Registry; Statins