January 22, 2020
Systematic Review Supports Statin Therapy for Critical Limb Ischemia
January 22, 2020—Findings from a systematic review and meta-analysis evaluating the efficacy of statins in the critical limb ischemia (CLI) population were published online ahead of print by Damianos G. Kokkinidis, MD, et al in Vascular Medicine.
The investigators concluded that statins are associated with decreased risk for amputation, mortality, and major adverse cardiac or cerebrovascular events (MACCE), as well as increased overall patency rates among patients with CLI. The study is registered as CRD42019134160 in the United Kingdom’s National Institute for Health Research PROSPERO register of systematic reviews.
For the study, investigators followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for transparent reporting. PubMed, Embase, and Cochrane Central databases were reviewed up to April 30, 2019.
As summarized in Vascular Medicine, the systematic review was composed of 19 studies including 26,985 patients with CLI. Among patients with known data on statin status, 12,292 (49.6%) were on statins versus 12,513 (50.4%) not on statins.
The primary outcomes included amputation rates and all-cause mortality. Secondary outcomes included primary patency rates, amputation-free survival, and MACCE. Risk of bias was assessed with the Robins-I tool for observational studies. A random-effects model meta-analysis was performed.
Heterogeneity was assessed with I2. Funnel plots and Egger’s test were used to assess publication bias.
The investigators reported the following:
- Patients treated with statins were 25% less likely to undergo amputation (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.59–0.95; I2 = 79%)
- Patients treated with statins were 38% less likely to have a fatal event (HR, 0.62; 95% CI, 0.52–0.75; I2 = 41.2%)
- Statin therapy was also associated with increased overall patency rates and lower incidence of MACCE
- There was substantial heterogeneity in the analysis for amputation and amputation-free survival (I2 > 70%)
Future studies should assess whether other lipid-lowering medications in addition to high-intensity statins can further improve outcomes among patients with CLI, advised the investigators in Vascular Medicine.