SLR - June 2019 - P. Wylie Burge
Statin Use Improves Limb Salvage After Intervention for Peripheral Arterial Disease
Reference: Parmar GM1, Novak Z2, Spangler E2, Patterson M2, Passman MA2, Beck AW2, Pearce BJ2. Statin Use Improves Limb Salvage After Intervention for Peripheral Arterial Disease. J Vasc Surg. 2019 Feb 1. pii: S0741-5214(18)32674-0. doi: 10.1016/j.jvs.2018.07.089.
Scientific Literature Review
Reviewed By: P. Wylie Burge, DPM
Residency Program: John Peter Smith Hospital, Fort Worth, TX
Podiatric Relevance: This article is of relevance to podiatric surgeons because a significant portion of our patient base is known to have peripheral arterial disease (PAD). Patients with a history of smoking, diabetes and cardiovascular disease are at a much higher risk of developing PAD, which contributes to lower-extremity ischemia tissue loss and amputation. A significant amount of podiatry patients will require vascular intervention. The use of statins in all patients with PAD is a class 1 recommendation according to the 2016 American Heart Association College of Cardiology PAD management guidelines. Despite clearly demonstrated cardiovascular and mortality benefits of statin use and peripheral arterial disease, its effects on limb salvage have not been explored. This paper attempts to correlate the use of statin therapy in patients with peripheral arterial disease with limb salvage outcomes. Treatment of underlying systemic disease in patients with PAD is a significant factor in outcomes of limb salvage both in preventing the progression of PAD and protecting bloodflow to the lower extremity for healing potential.
Methods: This study was a retrospective analysis of a prospectively maintained single institution database. Patients who underwent intervention for PAD between 2009 and 2010 at an academic medical center were identified from a prospectively maintained vascular registry. Information was collected from EMR and the Social Security Death Index. Demographic factors included age, race and sex. Before the intervention, patients were assessed for risk factors, including tobacco use, CAD, hypertension, hyperlipidemia, diabetes and kidney dysfunction. Indications for PAD intervention were classified into acute limb ischemia, critical limb ischemia and claudication. Interventions were either endovascular or open surgical. Information regarding medications was obtained from patients' medical records, and specific medications were isolated including, antiplatelet medications, statins, oral anticoagulants and cilostazol. The main outcomes of the study were freedom from above- or below-knee amputation and overall survival.
Results: A total of 488 PAD interventions were performed from January 2009 through December 2010. Sixty-one percent of cases were surgical, and 39 percent were endovascular. Among the included patients, 41 percent received statins, 56 percent received antiplatelets, 26 percent received oral anticoagulants and 7 percent received cilostazol. After adjusting for multiple variables, statin use had significantly improved overall survival at 30 days, one year and five years in comparison with nonusers. Statin users also had improved limb salvage at 30 days, one year and five years.
Conclusion: The study showed statin use independently significantly improved overall survival and limb salvage in patients with PAD after intervention. Statins are known to attenuate inflammation in plaque impact circulation and coronary as well as noncoronary circulation. This study indicates that statin use is significantly effective in increasing lower-extremity amputation. This effect is independent of the presence of diabetes or other atherosclerotic diseases.