Guideline-Directed Statin Therapy in Patients with New or Worsening Symptoms of Peripheral Artery Disease

Abstract

Objective: The ACC/AHA cholesterol guidelines recommend patients with peripheral artery disease (PAD) be treated with a moderate to high-intensity statin. The extent to which PAD patients with new or worsening claudication symptoms are offered guideline statin therapy is unknown. Methods: In the PORTRAIT registry, patterns of statin therapy were assessed in 1144 patients at 16 PAD specialty clinics (between June 2011-December 2015) before and after an evaluation for new or worsening claudication symptoms. It was documented whether patients had been previously treated with a guideline-directed statin as well as switched from non guideline to guideline statin therapy. Patient factors predicting intensification to guideline statin were examined. Site and provider-level variation in guideline statin intensification were summarized by calculating median odds ratios. Results: Among 1144 patients, 810 (70.8%) were initially on guideline therapy compared with 334 (29.2%) that were not. In the latter, 103 (30.8%) were prescribed guideline therapy after evaluation. Patients with typical symptoms displayed greater odds of intensification to guideline statin (OR 3.75; 95% CI: 1.22-11.53) while older patients had lower odds (OR 0.60/decade; 95% CI: 0.40-0.87). Variability in guideline statin intensification was observed across sites (Adjusted Median Odds Ratio = 3.63; 95% CI 1.88-5.42, (p <0.05)) but not providers (Adjusted Median Odds Ratio = 1.90; 95% CI 1.00-2.55, (p >0.05)). Conclusions: In conclusion, most patients evaluated at a PAD specialty clinic for new or worsening claudication symptoms arrived on a guideline-directed statin. Only 31% originally off guideline therapy were intensified to a guideline statin. These findings highlight an important opportunity to optimize medical therapy for patients with PAD.