Statins for Prevention of Cardiovascular Events in a Low-Risk Population With Low Ankle Brachial Index

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• 作者：Rafel Ramos ; MD ; PhD^a ; ^b ; ^c ; ^d ; ^{ramos.girona.ics@gencat.cat" class="auth_mail" title="E-mail the corresponding author} ; Maria Garcí ; a-Gil ; MD ; PhD^a ; ^b ; ^d ; Marc Comas-Cufí ; MSc^a ; ^b ; Miquel Quesada ; MD^a ; ^b ; ^c ; ^d ; Jaume Marrugat ; MD ; PhD^e ; ^f ; Roberto Elosua ; MD ; PhD^d ; ^e ; Joan Sala ; MD ; PhD^c ; ^f ; Marí ; a Grau ; MD ; PhD^e ; Ruth Martí ; PhD^a ; ^b ; ^c ; Anna Ponjoan ; MPh^a ; ^b ; ^c ; Lia Alves-Cabratosa ; MD^a ; ^b ; Jordi Blanch ; MSc^a ; ^b ; Bonaventura Bolí ; bar ; MD^a ; ^g
• 关键词：asymptomatic ; peripheral arterial disease ; primary prevention ; statin therapy
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：16 February 2016
• 年：2016
• 卷：67
• 期：6
• 页码：630-640
• 全文大小：1062 K

文摘

Evidence is lacking about the effectiveness of risk reduction interventions in patients with asymptomatic peripheral arterial disease.

Objectives

This study aimed to assess whether statin therapy was associated with a reduction in major adverse cardiovascular events (MACE) and mortality in this population.

Methods

Data were obtained from 2006 through 2013 from the Catalan primary care system’s clinical records database (SIDIAP). Patients age 35 to 85 years with an ankle-brachial index ≤0.95 and without clinically recognized cardiovascular disease (CVD) were included. Participants were categorized as statins nonusers or new-users (first prescription or represcribed after at least 6 months) and matched 1:1 by inclusion date and propensity score for statin treatment. Conditional Cox proportional hazards modeling was used to compare the groups for the incidence of MACE (myocardial infarction, cardiac revascularization, and ischemic stroke) and all-cause mortality.

Results

The matched-pair cohort included 5,480 patients (mean age 67 years; 44% women) treated/nontreated with statins. The 10-year coronary heart disease risk was low (median: 6.9%). Median follow-up was 3.6 years. Incidence of MACE was 19.7 and 24.7 events per 1,000 person-years in statin new-users and nonusers, respectively. Total mortality rates also differed: 24.8 versus 30.3 per 1,000 person-years, respectively. Hazards ratios were 0.80 for MACE and 0.81 for overall mortality. The 1-year number needed to treat was 200 for MACE and 239 for all-cause mortality.

Conclusions

Statin therapy was associated with a reduction in MACE and all-cause mortality among participants without clinical CVD but with asymptomatic peripheral arterial disease, regardless of its low CVD risk. The absolute reduction was comparable to that achieved in secondary prevention.