Statin uptake suboptimal in PAD, industry-funded study finds

Patients with peripheral artery disease (PAD) were less likely to be taking a statin compared to those with coronary heart disease (CHD) or cerebrovascular disease, despite having high risk for atherosclerotic cardiovascular disease (ASCVD) events, a study found.

Researchers conducted a retrospective cohort study of adults ages 19 years or older with commercial or Medicare health insurance who had a history of PAD, CHD, or cerebrovascular disease on Dec. 31, 2014. Patients were followed for ASCVD events, defined as CHD, cerebrovascular disease, and PAD events, until Dec. 31, 2017. The study was supported by a research grant from Amgen Inc., and two of the authors are Amgen Inc. employees and stockholders. The study results were published July 13 by the Journal of the American College of Cardiology.

Overall, 943,232 patients were included in the analysis. The age-standardized ASCVD event rates per 1,000 person-years for those with a history of one, two, and three conditions including PAD, CHD, and cerebrovascular disease were 40.8 (95% CI, 40.3 to 41.3), 68.9 (95% CI, 67.9 to 70.0), and 119.5 (95% CI, 117.0 to 122.0), respectively. ASCVD event rates per 1,000 person-years among patients with PAD only, CHD only, and cerebrovascular disease only were 34.7 (95% CI, 33.2 to 36.2), 42.2 (95% CI, 41.5 to 42.8), and 38.9 (95% CI, 37.6 to 40.1), respectively. Among patients with PAD and CHD, with PAD and cerebrovascular disease, and with CHD and cerebrovascular disease, ASCVD event rates per 1,000 person-years were 72.8 (95% CI, 71.0 to 74.7), 63.9 (95% CI, 60.6 to 67.4), and 67.9 (95% CI, 66.4 to 69.3), respectively. Statin use was lower in patients with PAD only (33.9%) than in those with cerebrovascular disease only (43.0%) or CHD only (51.7%).

“Despite their high risk for ASCVD events, patients with PAD are less likely to be taking a statin,” the authors concluded. “Taken together, results from the current study support the need for intensive ASCVD risk-reduction interventions including statin therapy among patients with a history of PAD.”

An accompanying editorial stated that the study findings highlight the underuse of lipid-lowering therapy and disparities in use based on “vascular territory,” with less statin use and lower intensity in patients with PAD.

“Randomized trials focused on specific populations and settings measuring relevant endpoints coupled with rigorous implementation of science and multidisciplinary care models may be a new approach to this chronic problem,” the editorial stated.