The real-world data of lipid-lowering treatment in patients with peripheral artery disease and its association with severity of disease

Hiroyoshi Komai; Masatsune Ogura; Hideki Sakashita; Noriyuki Miyama; Nobuko Yamamoto; Kanako Takai; Atsutoshi Hatada; Nobuhiro Tanimura; Takashi Nakamura; Masato Yoshida; Takayuki Kawaura; Tomomi Kitawaki; PROLIFERATION study group

doi:10.1016/j.jjcc.2023.10.002

The real-world data of lipid-lowering treatment in patients with peripheral artery disease and its association with severity of disease

J Cardiol. 2023 Oct 9:S0914-5087(23)00245-9. doi: 10.1016/j.jjcc.2023.10.002. Online ahead of print.

Affiliations

¹ Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan. Electronic address: komaihir@takii.kmu.ac.jp.
² Department of Clinical Laboratory Technology, Faculty of Medical Science, Juntendo University, Urayasu, Chiba, Japan.
³ Department of Vascular Surgery, Kansai Medical University Medical Center, Moriguchi, Osaka, Japan.
⁴ Department of Cardiovascular Surgery, Saiseikai Wakayama Hospital, Wakayama, Japan.
⁵ Department of Vascular Surgery, Aijinkai Inoue Hospital, Suita, Osaka, Japan.
⁶ Department of Vascular Surgery, Osaka Rosai Hospital, Sakai, Japan.
⁷ Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
⁸ Department of Mathematics, Kansai Medical University, Hirakata, Osaka, Japan.

PMID: 37816481
DOI: 10.1016/j.jjcc.2023.10.002

Abstract

Background: The risk of coronary artery disease in peripheral arterial disease (PAD) is high, life prognosis is poor, and lipid-lowering treatment with statins has been reported to improve prognosis. In clinical practice, however, hypolipidemia is more common in patients with severe PAD and statin prescription rates appear to be low, but specific data are scarce in Japan. Therefore, we conducted this cross-sectional study in collaboration with other centers of vascular surgery to determine the rate of statin prescriptions for PAD patients in real-world practice, the rate of achievement of low-density lipoprotein (LDL) cholesterol control targets, and whether statin non-use is a determinant factor of critical limb ischemia (CLI).

Methods: A total of 246 PAD patients (97 with CLI) from 5 sites were included in this study. Medical history and blood test data were obtained from medical records and interviews with patients, and were compared between CLI and non-CLI patients.

Results: Statin prescription rate was only 34 %. The overall LDL cholesterol control target rate was 46 % of CLI cases and 51 % of non-CLI cases, according to the lipid management criteria of the Japanese Society for Atherosclerosis 2022 guidelines. Patients in the CLI group had a lower mean body mass index and lower LDL cholesterol levels than those in the non-CLI group, suggesting that these factors were responsible for the lower statin prescription rate. However, multivariate analysis revealed that statin non-use was one of the determinants of CLI.

Conclusions: Statin prescription rates for PAD patients were low in real-world practice settings in the field of vascular surgery. Since statin non-use is a determinant of CLI, there is a need to educate physicians engaged in treatment regarding lipid-lowering treatment with statins.

Keywords: Critical limb ischemia; Dyslipidemia; Nutrition; Peripheral arterial disease; Statin.