TY - JOUR
T1 - Effectiveness of Blood Lipid Management in Patients With Peripheral Artery Disease
AU - Hess, Connie N.
AU - Cannon, Christopher P.
AU - Beckman, Joshua A.
AU - Goodney, Philip P.
AU - Patel, Manesh R.
AU - Hiatt, William R.
AU - Mues, Katherine E.
AU - Orroth, Kate K.
AU - Shannon, Erin
AU - Bonaca, Marc P.
N1 - Funding Information:
This study was funded through a research grant from Amgen to CPC Clinical Research. Dr. Hess has received research funding to CPC Clinical Research from Merck, Bayer, Janssen, and Amgen. Dr. Cannon has received research grants from Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi-Sankyo, Janssen, Merck, and Pfizer; and has received consulting fees from Aegerion, Alnylam, Amarin, Amgen, Applied Therapeutics, Ascendia, BI, BMS, Corvidia, Eli Lilly, HLS Therapeutics, Innovent, Janssen, Kowa, Merck, Pfizer, Rhoshan, and Sanofi. Dr. Beckman has provided consulting for AstraZeneca, Amgen, Bayer, GlaxoSmithKline, Janssen, and Sanofi; has provided Data Safety and Monitoring Board service for Novartis; and has ownership in EMX and Janacare. Dr. Patel has received research grants from/served on the advisory board for Bayer, Janssen, Amgen, and Heartflow; and has received research grants from Novartis and the National Heart, Lung, and Blood Institute. Dr. Hiatt has received grant support to CPC Clinical Research from the National Institutes of Health, Bayer, Janssen, Amgen, and Pluristem. Drs. Mues and Orroth and Ms. Shannon are employees of Amgen, Inc. Dr. Bonaca has received research grants to CPC Clinical Research from Amgen, AstraZeneca, Bayer, NovoNordisk, Regeneron, and Sanofi. Dr. Goodney has reported that he has no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2021 American College of Cardiology Foundation
PY - 2021/6/22
Y1 - 2021/6/22
N2 - Background: Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in peripheral artery disease (PAD). Lipid-lowering therapies (LLT) that reduce LDL-C decrease this risk. Objectives: The authors examined LLT use and actual achieved LDL-C in PAD. Methods: PAD patients in MarketScan from 2014 to 2018 were identified. Outcomes included LLT use, defined as high-intensity (HI) (high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor), low-intensity (any other lipid regimen), or no therapy, and follow-up LDL-C. Factors associated with LDL-C <70 mg/dl were identified with multivariable logistic regression. Results: Among 250,103 PAD patients, 20.5% and 39.5% were treated at baseline with HI and low-intensity LLT, respectively; 40.0% were on no LLT. Over a 15-month median follow-up period, HI LLT use increased by 1.5%. Among 18,747 patients with LDL-C data, at baseline, 25.1% were on HI LLT, median LDL-C was 91 mg/dl, and 24.5% had LDL-C <70 mg/dl. Within the HI LLT subgroup, median LDL-C was 81 mg/dl, and 64% had LDL-C ≥70 mg/dl. At follow-up, HI LLT use increased by 3.7%, median LDL-C decreased by 4.0 mg/dl, and an additional 4.1% of patients had LDL-C <70 mg/dl. HI LLT use was greater after follow-up MACE (55.0%) or MALE (41.0%) versus no ischemic event (26.1%). After MACE or MALE, LDL-C was <70 mg/dl in 41.5% and 36.1% of patients, respectively, versus 27.1% in those without an event. Factors associated with follow-up LDL-C <70 mg/dl included smoking, hypertension, diabetes, prior lower extremity revascularization, and prior myocardial infarction but not prior acute or critical limb ischemia. Conclusions: In PAD, LLT use is suboptimal, LDL-C remains elevated, and LLT intensity is a poor surrogate for achieved LDL-C. Less aggressive lipid management was observed in PAD versus cardiovascular disease, highlighting missed opportunities for implementation of proven therapies in PAD.
AB - Background: Low-density lipoprotein cholesterol (LDL-C) is associated with heightened risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in peripheral artery disease (PAD). Lipid-lowering therapies (LLT) that reduce LDL-C decrease this risk. Objectives: The authors examined LLT use and actual achieved LDL-C in PAD. Methods: PAD patients in MarketScan from 2014 to 2018 were identified. Outcomes included LLT use, defined as high-intensity (HI) (high-intensity statin, statin plus ezetimibe, or PCSK9 inhibitor), low-intensity (any other lipid regimen), or no therapy, and follow-up LDL-C. Factors associated with LDL-C <70 mg/dl were identified with multivariable logistic regression. Results: Among 250,103 PAD patients, 20.5% and 39.5% were treated at baseline with HI and low-intensity LLT, respectively; 40.0% were on no LLT. Over a 15-month median follow-up period, HI LLT use increased by 1.5%. Among 18,747 patients with LDL-C data, at baseline, 25.1% were on HI LLT, median LDL-C was 91 mg/dl, and 24.5% had LDL-C <70 mg/dl. Within the HI LLT subgroup, median LDL-C was 81 mg/dl, and 64% had LDL-C ≥70 mg/dl. At follow-up, HI LLT use increased by 3.7%, median LDL-C decreased by 4.0 mg/dl, and an additional 4.1% of patients had LDL-C <70 mg/dl. HI LLT use was greater after follow-up MACE (55.0%) or MALE (41.0%) versus no ischemic event (26.1%). After MACE or MALE, LDL-C was <70 mg/dl in 41.5% and 36.1% of patients, respectively, versus 27.1% in those without an event. Factors associated with follow-up LDL-C <70 mg/dl included smoking, hypertension, diabetes, prior lower extremity revascularization, and prior myocardial infarction but not prior acute or critical limb ischemia. Conclusions: In PAD, LLT use is suboptimal, LDL-C remains elevated, and LLT intensity is a poor surrogate for achieved LDL-C. Less aggressive lipid management was observed in PAD versus cardiovascular disease, highlighting missed opportunities for implementation of proven therapies in PAD.
KW - lipid management
KW - outcomes
KW - peripheral artery disease
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U2 - 10.1016/j.jacc.2021.04.060
DO - 10.1016/j.jacc.2021.04.060
M3 - Article
C2 - 34140105
AN - SCOPUS:85107428003
SN - 0735-1097
VL - 77
SP - 3016
EP - 3027
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 24
ER -