Abstract P039: Low-density Lipoprotein Management In Patients With Peripheral Artery Disease With And Without Severe Hypercholesterolemia In A Largely Rural Population

Abstract

Background: Elevated low-density lipoprotein cholesterol (LDL) is associated with increased risk for peripheral artery disease (PAD) and major limb or adverse cardiovascular events. We aimed to compare the prevalence and appropriate lipid-lowering treatment of patients diagnosed with PAD with and without prior phenotypic severe hypercholesterolemia (SH) in a large, rural healthcare system. Methods: Retrospective study of ambulatory adults with a lipid panel at Essentia Health clinics obtained between 7/1/2016-6/30/2019 (MN, WI, and ND, USA) with PAD on the problem list (defined based on ICD-9/10 codes). Patients were divided into two groups, PAD only and PAD with SH. Phenotypic SH was defined as any prior LDL ≥ 190 mg/dL. Patients were excluded if they were currently pregnant (n=232) or if they did not have repeat LDL > 30 days apart (n=1684). High-intensity statin was considered atorvastatin 40mg or 80mg or rosuvastatin 20mg or 40mg daily. Results: A total of 10,874 patients were previously diagnosed with PAD (mean age 40.4 + 10.9, 43.3% female (N=4711), 58.1% rural (N=6319). A total of 13.6% (N=1484) had SH. Patients with PAD and SH were more likely to be female, urban, have prior acute limb ischemia, stroke/transient ischemic attack, and were less likely to have diabetes or chronic limb ischemia than patients with PAD only. Patients with PAD and SH were more likely to be on a high intensity statin than those with PAD only (65.8% (N=977) vs. 51.3% (N=4813); p<0.001). Very few patients received no lipid-lowering therapy (PAD with SH 0.7% (N=10) vs. PAD alone 2.1% (N=234). More patients with PAD and SH received PCKS9 inhibitors (2.5% (N=37) vs 0.4% (N=39); p<0.001) and ezetimibe (23.4% (N=347) vs. 8.1% (N=760); p<0.001) than patients with PAD only. Approximately 50% (N=749) of PAD with SH patients achieved a 50% lowering from peak LDL compared to 28.9% (N=2717) with PAD only. Mean LDL in the PAD with SH was 113.9 + 43.4 mg/dL compared to 81.8 + 29.1 mg/dL in patients with PAD without SH. However, fewer patients with PAD and SH achieved a LDL <70 mg/dL compared to those with PAD only (13.3% (N=197) vs 37.1% (N=3487), p< 0.001). Conclusion: One in 10 patients with PAD has a history of SH and majority are not achieving target LDL<70mg/dL. There is an urgent need for more aggressive lipid-lowering therapy for all patients with PAD.