Association between statin medications and mortality, major adverse cardiovascular event, and amputation-free survival in patients with critical limb ischemia
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Objectives The aim of this study was to determine the associations between statin use and major adverse cardiovascular and cerebrovascular events (MACCE) and amputation-free survival in critical limb ischemia (CLI) patients.Background CLI is an advanced form of peripheral arterial disease associated with nonhealing arterial ulcers and high rates of MACCE and major amputation. Although statin medications are recommended for secondary prevention in peripheral arterial disease, their effectiveness in CLI is uncertain.Methods We reviewed 380 CLI patients who underwent diagnostic angiography or therapeutic endovascular intervention from 2006 through 2012. Propensity scores and inverse probability of treatment weighting were used to adjust for baseline differences between patients taking and not taking statins.Results Statins were prescribed for 246 (65%) patients. The mean serum low-density lipoprotein (LDL) level was lower in patients prescribed statins (75 ± 28 mg/dl vs. 96 ± 40 mg/dl, p < 0.001). Patients prescribed statins had more baseline comorbidities including diabetes, coronary artery disease, and hypertension, as well as more extensive lower extremity disease (all p values <0.05). After propensity weighting, statin therapy was associated with lower 1-year rates of MACCE (stroke, myocardial infarction, or death; hazard ratio [HR]: 0.53; 95% confidence interval [CI]: 0.28 to 0.99), mortality (HR: 0.49, 95% CI: 0.24 to 0.97), and major amputation or death (HR: 0.53, 95% CI: 0.35 to 0.98). Statin use was also associated with improved lesion patency among patients undergoing infrapopliteal angioplasty. Patients with LDL levels >130 mg/dl had increased HRs of MACCE and mortality compared with patients with lower levels of LDL.Conclusions Statins are associated with lower rates of mortality and MACCE and increased amputation-free survival in CLI patients.
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In critical limb ischaemia, statin therapy improved 1-year mortality and major adverse cardiovascular events and increased amputation-free survival.
“Even in the most advanced stages of the disease (critical limb ischaemia), statin therapy improved rates of 1-year mortality and major adverse CV events and increased amputation-free survival.409”
From 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias (2016) · cites this paper as [409]
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References 49 · Cited by 189
- Authors
- Westin, G. G., Armstrong, E. J., Bang, H., Yeo, K.-K., Anderson, D., Dawson, D. L., Pevec, W. C., Amsterdam, E. A., & Laird, J. R.
- Affiliations
- University of California Davis Medical Center (US)
- University of California, Davis (US)
- Corresponding author
- Laird, John R.
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2014-02
- Volume
- 63
- Issue
- 7
- Pages
- 682-690
- ISSN
- 0735-1097 (ISSN-L)
- PMC
- PMC3944094
- OpenAlex
- W2092050899
- Cited by
- 189
- References
- 49
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 20 · 2023: 9 · 2022: 13 · 2021: 15 · 2020: 24 · 2019: 11 · 2018: 18 · 2017: 19 · 2016: 20 · 2015: 14 · 2014: 11 · 2013: 2
- FWCI
- 15.46
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Center for Advancing Translational Sciences
- National Institutes of Health (UL1 TR 000002, TL1 TR 000133)
- Medtronic
- Topics
- Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Keywords
- statins, critical limb ischemia, major adverse cardiovascular events, mortality, amputation-free survival, peripheral arterial disease, LDL cholesterol, infrapopliteal angioplasty, secondary prevention, stroke, myocardial infarction
- MeSH terms
- Aged, Aged, 80 and over, Amputation, Surgical, Cardiovascular Diseases, Extremities, Female, Follow-Up Studies, Humans, Ischemia, Male, Middle Aged, Registries, Retrospective Studies, Survival Rate, Critical Illness, Treatment Outcome, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Limb Salvage
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