Impact of Goal-Directed Statin Therapy on Open and Endovascular Interventions for Claudication Owing to Superficial Femoral Artery Disease

Abstract

Controlling lipids, in particular cholesterol and low-density lipoprotein cholesterol, has been identified as a key intervention to prevent adverse systemic events in patients with a high atherosclerotic burden and claudication. It is unclear if goal-directed therapy of to achieve a decrease in cholesterol (<200 mg/dL) and in low-density lipoprotein (<100 mg/dL) will influence outcomes. The aim of study was to determine the incidence and effectiveness of statin therapy on patient and procedural outcomes after SFA interventions for claudication. A database of patients with claudication undergoing open and endovascular intervention for TransAtlantic Inter-Society Consensus II C and D femoropopliteal lesions between 2001 and 2017 was retrospectively queried. All patients were on statins at the time of the procedure. Patients were subdivided into those based on serum cholesterol and low-density lipoprotein goals: neither goal met (no effect), one of two goals met (partial), or both goals met (full). Kaplan-Meier survival analyses were performed to assess time-dependent outcomes. Factor analyses were performed using a Cox proportional hazard model for time-dependent variables. There were 1973 patients (68% male; average age, 67 years) who underwent Open and endovascular treatment for symptomatic superficial femoral artery disease. Only 52% were on statins before the procedure. Both partial and full efficacy influenced 30-day outcomes and was associated with improved freedom from major adverse limb events and amputation-free survival at 5 years (Table). Partial or fully effective goal directed statin therapy has a significant effect on 30-day and long term outcomes in patients presenting with claudication and advanced femoropopliteal disease.TableThirty-day outcomesStatin efficacyNo effectPartial effectFull effect30-day MACE (%)21a0b,c30-day MALE (%)62b1b,c30-day amputation (%)21a0b,cFreedom from MALE (%)46 ± 673 ± 8b81 ± 9a,bAmputation-free survival (%)59 ± 788 ± 8b93 ± 9a,bMACE, Major adverse cardiac events; MALE, major adverse limb events.aP < .05 and bP < .01 compared with Full cP < .05 and dP < .01 compared with Partial. Open table in a new tab