Preventive cardiology
Effect of Statin Therapy on Mortality in Patients With Peripheral Arterial Disease and Comparison of Those With Versus Without Associated Chronic Obstructive Pulmonary Disease

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Chronic obstructive pulmonary disease (COPD) and peripheral arterial disease (PAD) are both inflammatory conditions. Statins are commonly used in patients with PAD and have anti-inflammatory properties, which may have beneficial effects in patients with COPD. The relation between statin use and mortality was investigated in patients with PAD with and without COPD. From 1990 to 2006, we studied 3,371 vascular surgery patients. Statin use was noted at baseline and, if prescribed, converted to <25% (low dose) and ≥25% (intensified dose) of the maximum recommended therapeutic dose. The diagnosis of COPD was based on the Global Initiative for Chronic Obstructive Lung Disease guidelines using pulmonary function test. End points were short- (30-day) and long-term (10-year) mortality. A total of 330 patients with COPD (25%) used statins, and 480 patients (23%) without COPD. Statin use was independently associated with improved short- and long-term survival in patients with COPD (odds ratio 0.48, 95% confidence interval [CI] 0.23 to 1.00; hazard ratio 0.67, 95% CI 0.52 to 0.86, respectively). In patients without COPD, statins were also associated with improved short- and long-term survival (odds ratio 0.42, 95% CI 0.20 to 0.87; hazard ratio 0.76, 95% CI 0.60 to 0.95, respectively). In patients with COPD, only an intensified dose of statins was associated with improved short-term survival. However, for the long term, both low-dose and intensive statin therapy were beneficial. In conclusion, statin use was associated with improved short- and long-term survival in patients with PAD with and without COPD. Patients with COPD should be treated with an intensified dose of statins to achieve an optimal effect on both the short and long term.

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Methods

From 1990 to 2006, a total of 3,371 consecutive patients underwent elective vascular surgery at the Erasmus Medical Center, Rotterdam, The Netherlands. Surgical procedures included abdominal aortic surgery (AAA), carotid endarterectomy (CAE), or lower-limb arterial reconstruction (LLR). Patients with AAA surgery underwent infrarenal AAA repair (aortic-to-aortic or aortic-bifurcation prostheses procedures, removal of infected prostheses, and other operations of the abdominal aorta). CEA surgery

Results

Baseline characteristics according to the presence of COPD and statin use were listed in Table 1. Mean age of the 3,371 patients was 66 ± 13 years, and 73% were men. Overall, 24% (n = 810) were statin users. Of the total patients with COPD, 25% used statins, and of patients without COPD, 23%. Statins were more frequently prescribed to patients who underwent CEA and less frequently in patients who underwent LLR (both p <0.001) in patients with and without COPD. Patients who received statins more

Discussion

Results of the present study confirmed the known beneficial effect of statins on short- and long-term mortality in patients with PAD and showed that this effect extended to patients with COPD. We found that intensive therapy was superior to low-dose therapy in reducing short- and long-term mortality in patients with COPD.

Consistent with our findings, several studies have shown that statin therapy reduced the mortality in patients with PAD undergoing vascular surgery.4, 5, 6, 7 We extended these

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Yyette R.B.M. van Gestel and Sanne E. Hoeks were supported by an unrestricted research grant from Lijf & Leven Foundation, Rotterdam, The Netherlands. Dr. Schouten was supported by an unrestricted research grant from The Netherlands Organization of Heart Research and Development (ZonMW), The Hague, The Netherlands.

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