Poor attainment of lipid targets in patients with symptomatic peripheral artery disease

Abstract

Patients with peripheral artery disease (PAD) are at very high risk of future cardiovascular (CV) events. Strict lipid-lowering therapy is recommended. However, data on target level attainment are scarce. The objective of the study was to investigate guideline equitable lipid lowering in a large observational study of symptomatic PAD patients. Single-center observational study including 1109 patients with symptomatic PAD planned for revascularization at a tertiary university center. Between 2010 and 2017, guideline target level attainment trends over time and the association of statin therapy with CV mortality were analyzed. Atorvastatin (52.3%) and rosuvastatin (23.5%) were the most frequently prescribed statins and amounted to an average simvastatin equivalent of 52mg/d. Attainment rates of low-density lipoprotein cholesterol (LDL-C) and of non-high-density lipoprotein cholesterol goals were as low as 27% and 33%, respectively. Although there was a significant improvement of LDL-C from 2010 to 2017 (mean LDL-C 110 vs 80mg/dL, P<.0001 for trend), attainment remained poor, that is, only 42% in 2016 and 45% in 2017 achieved the <70mg/dL goal. CV mortality was significantly lower (4% vs 11%, P<.01) in statin-treated patients over a median follow-up period of 50±26months. There is a remarkable undertreatment of LDL-C and non-high-density lipoprotein cholesterol in patients with symptomatic PAD, although LDL-C decreased significantly from 2010 to 2017. As statin treatment was associated with a reduced CV mortality rate, our findings call for an increased awareness in clinical lipidology regarding symptomatic PAD patients.