Introduction: Prior studies have demonstrated adverse cardiovascular risk in patients with peripheral arterial disease (PAD) and less optimal control of major risk factors. The impact of aggressive multiple risk factor control in PAD patients has not been well characterized.
Methods: ACCELERATE compared the effects of evacetrapib and placebo in 12,092 statin-treated patients with atherosclerotic cardiovascular disease. Major adverse cardiovascular event (MACE) rates were compared in patients with PAD (n=752), coronary artery disease (CAD, n=9274) and their combination (n=1603) and in the setting of intensive risk factor control.
Results: Patients with PAD had a higher prevalence of current smoking (31.5% Vs 13.8%, P<0.001), less diabetes (50.3% vs. 72.1%, P<0.001), and were less likely to be treated with aspirin (65.6% vs 85.7%, P<0.001) and antihypertensive agents (80.1% vs 86.8%, P<0.001) compared to those with CAD. A greater MACE rate was observed in patients with both PAD and CAD, compared with CAD alone (20.2% vs 13.3%, P<0.001). Patients with PAD were more likely to achieve a HbA1c <7% (67.3% vs 56.2%, P<0.001), but less likely to achieve a LDL-C <70 mg/dl (50.0% vs 59.5, P<0.001), systolic BP <130 mmHg (35.2% vs 50.3%, P<0.001) and hsCRP <2mg/L (46.1% vs 60.4%, P<0.001) compared to those with CAD. Greater MACE rates were observed in PAD patients even in the setting of LDL-C <70mg/dL (15.1% vs 10.2%, P<0.001), systolic BP <120 mmHg (14.3% vs 9.3%, P<0.002), hsCRP <1 mg/L (12.4% vs 9.4%, p<0.04) and triglycerides <150 mg/dL (13.7% vs 11.0%, p<0.003), compared to those without PAD.
Conclusion: The presence of PAD in patients with CAD is associated with an elevated risk of MACE. Despite intensive risk factor modification, elevated MACE rates continue to be observed in PAD patients suggesting the need to develop additional approaches to reducing cardiovascular risk in these patients.