Study Confirms Importance of Adherence to Guideline-Recommended Therapy for PAD

April 10, 2014—In the Journal of the American Heart Association (JAHA), Ehrin J. Armstrong, MD, et al have published a study demonstrating that adherence to guideline-recommended therapy is associated with decreased major cardiovascular events (MACE) and major adverse limb events (MALE) among patients with peripheral arterial disease (PAD). The open-access JAHA article is available online.

According to the investigators, current guidelines recommend that patients with PAD cease smoking and be treated with aspirin, statin medications, and angiotensin‐converting enzyme (ACE) inhibitors. However, the combined effects of multiple guideline‐recommended therapies in patients with symptomatic PAD have not been well characterized.

As summarized in JAHA, the investigators analyzed a comprehensive database of all patients with claudication or critical limb ischemia (CLI) who underwent diagnostic or interventional lower extremity angiography between June 1, 2006, and May 1, 2013, at a multidisciplinary vascular center. They obtained baseline demographics, clinical data, and long‐term outcomes. Inverse probability of treatment propensity weighting was used to determine the 3‐year risk of MACE (myocardial infarction, stroke, or death) and MALE (major amputation, thrombolysis, or surgical bypass). 

The investigators reported that among 739 patients with PAD, 325 (44%) had claudication and 414 (56%) had CLI. Guideline‐recommended therapies at baseline included use of aspirin in 651 (88%), statin medications in 496 (67%), ACE inhibitors in 445 (60%), and smoking abstention in 528 (71%) patients. A total of 237 patients (32%) met all four guideline‐recommended therapies. 

After adjustment for baseline covariates, patients adhering to all four guideline‐recommended therapies had decreased MACE (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.45–0.89; P = .009), MALE (HR, 0.55; 95% CI, 0.37–0.83; P = .005), and mortality (HR, 0.56; 95% CI, 0.38–0.82; P = .003) rates compared to patients receiving fewer than four of the recommended therapies.

In patients with claudication or CLI, combination treatment with four guideline‐recommended therapies is associated with significant reductions in MACE, MALE, and mortality, concluded the investigators in JAHA.