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Thromb Haemost 2020; 120(05): 866-875
DOI: 10.1055/s-0040-1709711
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Statins and Major Adverse Limb Events in Patients with Peripheral Artery Disease: A Systematic Review and Meta-Analysis

Daniele Pastori   *
1   Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
,
Alessio Farcomeni   *
2   Department of Economics and Finance, University of Rome “Tor Vergata”, Rome, Italy
,
Alberto Milanese
3   Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
,
Francesco Del Sole
1   Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
,
Danilo Menichelli
1   Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
,
William R. Hiatt   **
4   Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
5   Division of Cardiology and CPC Clinical Research, University of Colorado School of Medicine, Aurora, Colorado, United States
,
Francesco Violi   **
1   Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Italy
› Author Affiliations Funding None.
Further Information

Publication History

10 December 2019

05 March 2020

Publication Date:
05 May 2020 (online)

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Abstract

Background Statins are guidelines recommended in patients with peripheral artery disease (PAD) for the prevention of cardiovascular (CV) events. Comprehensive meta-data on the impact of statins on major adverse limb events (MALE) in PAD patients are lacking. We examined the association of statin use with MALE in patients with PAD.

Methods We performed a systematic review (registered at PROSPERO: number CRD42019137111) and metanalysis of studies retrieved from PubMed (via MEDLINE) and Cochrane (CENTRAL) databases addressing the impact of statin on MALE including amputation and graft occlusion/revascularization. Secondary endpoints were all-cause death, composite CV endpoints, CV death, and stroke.

Results We included 51 studies with 138,060 PAD patients, of whom 48,459 (35.1%) were treated with statins. The analysis included 2 randomized controlled trials, 20 prospective, and 29 retrospective studies. Overall, 11,396 MALE events, 21,624 deaths, 4,852 composite CV endpoints, 4,609 CV deaths, and 860 strokes were used for the analysis. Statins reduced MALE incidence by 30% (pooled hazard ratio [HR]: 0.702; 95% confidence interval [CI]: 0.605–0.815) and amputations by 35% (HR: 0.654; 95% CI: 0.522–0.819), all-cause mortality by 39% (pooled HR: 0.608, 95% CI: 0.543–0.680), CV death by 41% (HR: 0.594; 95% CI: 0.455–0.777), composite CV endpoints by 34% (pooled HR: 0.662; 95% CI: 0.591–0.741) and ischemic stroke by 28% (pooled HR: 0.718; 95% CI: 0.620–0.831).

Conclusion Statins reduce the incidence of MALE, all-cause, and CV mortality in patients with PAD. In PAD, a high proportion of MALE events and deaths could be prevented by implementing a statin prescription in this patient population.

Keywords

statin - peripheral artery disease - major adverse limb event - stroke - amputation - cardiovascular death - all-cause death

* Equal contribution.


** Joint senior authorship.


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