Background: Studies have demonstrated benefit of statin therapy in patients with peripheral artery disease (PAD). However, use of statins in patients with PAD has been found to be suboptimal. We examined trends in statin use and discontinuation among adults with severe PAD including critical limb ischemia (CLI) from 2002-2015.
Methods: Using electronic health record data from a large, integrated healthcare delivery system, we identified patients aged ≥40 yrs with incident severe PAD/CLI and 12 months of prior continuous coverage of health and drug benefits. Statin intensity was defined at first prescription fill. Discontinuation of statin therapy was defined as the first 90-day gap in treatment within 1 yr after diagnosis.
Results: We identified 11,059 patients with incident severe PAD/CLI from 2002-2015. Mean (SD) age was 69 (11.3) yrs, 40% were female, 54% were White, 23% Hispanic, 16% Black and 4% Asian/Pacific Islander. Statin use in the yr before diagnosis increased from 50% in 2002 to 66% in 2015. Overall, 60% (n=6578) were on a statin in the yr before diagnosis. Of these patients, 18%, 54% and 28% were receiving high, moderate and low intensity statins, respectively. The proportion of patients on high intensity statins increased from 7.3% in 2002 to 41.9% in 2015 while the proportion on low intensity statins decreased (Figure). Of the 40% (n=4481) who were not on a statin in the yr before diagnosis, 13.5% (n=607) newly initiated statin therapy within 1 month after diagnosis. The proportion of patients with no statin use increased with increasing LDL-C, while the percentage with any statin use decreased (Figure). Following diagnosis of PAD/CLI, 13% discontinued statin therapy within 1 yr.
Conclusions: Use of statins and high intensity statins increased from 2002-2015 among a population of patients with severe PAD including CLI. However, a substantial proportion remained untreated with statins, representing a significant treatment gap in this population at high risk for cardiovascular events and adverse limb outcomes.