MedicalResearch.com Interview with:
Shipra Arya MD, SM
Assistant Professor, Division of Vascular Surgery
Emory University School of Medicine
Assistant Professor of Epidemiology (Adjunct)
Rollins School of Public Health
Staff Physician, Atlanta VA Medical Center
Director, AVAMC Vascular Lab and Endovascular Therapy
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Arya: Peripheral Arterial Disease is the next cardiovascular epidemic. It is poorly recognized and not adequately treated compared to heart disease – and research is lacking on the optimal use of statins for PAD patients. Very few randomized clinical trials have been done specifically in PAD patients to assess the impact of statins on cardiovascular outcomes and none on limb related outcomes. The 2013 ACC/AHA guidelines for cholesterol lowering medications recommends high intensity statins for PAD patients extrapolated from the level 2 and 3 evidence and empirically based on CAD and stroke data.
In this study we looked at the amputation and mortality risk based on statin dosage in a large cohort of patients from the VA population and found that high intensity statins are associated with a significant reduction in limb loss (~30%) and mortality (~25%) in PAD patients followed by a smaller risk reduction [~23% for amputation risk reduction and 20% reduction in mortality risk] by low-moderate intensity statins as compared to no statin therapy.
MedicalResearch.com: What should readers take away from your report?
Dr. Arya: Patients with clinical PAD should be on statin therapy and preferably a high intensity statin to derive the maximum benefit in terms of reducing risk of death and amputation over the long run.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Dr. Arya: Our study is based on observation al data and does not provide causal effect. A randomized clinical trial would be helpful to quantify the benefit of high dose statins and assess possible mechanisms and adverse events if any. Future research also needs to focus on barriers to care, patients and provider education and implementation of quality improvement initiatives to increase the use of statin therapy in the PAD population.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Arya: Ours is one of the largest population-based studies on PAD and suggests patients who have been diagnosed with PAD should be considered for placement on high dose statins upon diagnosis if they can tolerate it, along with other medical management, including smoking cessation, antiplatelet therapy and a walking program,
MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.
Arya S, Khakharia A, Binney ZO, et al. Statins have a dose-dependent effect on amputation risk and survival in peripheral arterial disease (PAD) patients. Presented at: Arteriosclerosis, Thrombosis, and Vascular Biology | Peripheral Vascular Disease 2016 Scientific Sessions. May 6, 2016. Nashville, TN.
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