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Statins for prevention of cardiovascular events in a low-risk population with low ankle brachial index
- Source :
- Journal of the American College of Cardiology, 2016, vol. 67, núm. 6, p. 630-640, Articles publicats (D-CM), DUGiDocs – Universitat de Girona, instname
- Publication Year :
- 2016
- Publisher :
- Elsevier, 2016.
-
Abstract
- BACKGROUND: Evidence is lacking about the effectiveness of risk reduction interventions in patients with asymptomatic peripheral arterial disease. OBJECTIVES: This study aimed to assess whether statin therapy was associated with a reduction in major adverse cardiovascular events (MACE) and mortality in this population. METHODS: Data were obtained from 2006 through 2013 from the Catalan primary care system's clinical records database (SIDIAP). Patients age 35 to 85 years with an ankle-brachial index ≤0.95 and without clinically recognized cardiovascular disease (CVD) were included. Participants were categorized as statins nonusers or new-users (first prescription or represcribed after at least 6 months) and matched 1:1 by inclusion date and propensity score for statin treatment. Conditional Cox proportional hazards modeling was used to compare the groups for the incidence of MACE (myocardial infarction, cardiac revascularization, and ischemic stroke) and all-cause mortality. RESULTS: The matched-pair cohort included 5,480 patients (mean age 67 years; 44% women) treated/nontreated with statins. The 10-year coronary heart disease risk was low (median: 6.9%). Median follow-up was 3.6 years. Incidence of MACE was 19.7 and 24.7 events per 1,000 person-years in statin new-users and nonusers, respectively. Total mortality rates also differed: 24.8 versus 30.3 per 1,000 person-years, respectively. Hazards ratios were 0.80 for MACE and 0.81 for overall mortality. The 1-year number needed to treat was 200 for MACE and 239 for all-cause mortality. CONCLUSIONS: Statin therapy was associated with a reduction in MACE and all-cause mortality among participants without clinical CVD but with asymptomatic peripheral arterial disease, regardless of its low CVD risk. The absolute reduction was comparable to that achieved in secondary prevention. This project was supported by clinical research grants from the Ministerio de Salud (EC10-84, EC10-83); Spain’s Ministry of Science and Innovation through the Carlos III Health Institute, cofinanced with European Union ERDF funds (Network for Prevention and Health Promotion in primary Care RedIAPP RD12/0005, Programa HERACLES RD12/0042, and Miguel Servet Contract CP12/03287); and by the Departament de Salut, Generalitat de Catalunya, Agency for Health Technology Assessment (AATRM 034/33/02), and Agency for Management of University and Research Grants (2005SGR00577). Drs. Ramos and Garcia-Gil collaborate (without receiving any personal fee) in 2 projects of primary care for the institute IDIAP Jordi Gol funded by AstraZeneca and AMGEN that are unrelated to the present work. Dr. Marrugat has received lecture fees from Ferrer-in-Code; holds a patent with Gendiag SL; and has received payment for development of educational presentations from AstraZeneca.
- Subjects :
- Male
primary prevention
Artèries -- Malalties
Sistema cardiovascular -- Malalties
030204 cardiovascular system & hematology
0302 clinical medicine
Risk Factors
030212 general & internal medicine
Myocardial infarction
Aged, 80 and over
education.field_of_study
Incidence
Middle Aged
Survival Rate
Treatment Outcome
Atenció primària
Cardiovascular Diseases
Number needed to treat
Female
medicine.symptom
Cardiology and Cardiovascular Medicine
Adult
medicine.medical_specialty
Statin
medicine.drug_class
Population
Asymptomatic
03 medical and health sciences
peripheral arterial disease
Internal medicine
medicine
asymptomatic
Humans
Ankle Brachial Index
cardiovascular diseases
education
Primary care (Medicine)
Aged
Retrospective Studies
Dose-Response Relationship, Drug
business.industry
Proportional hazards model
Cardiovascular system -- Diseases
Statins (Cardiovascular agents)
Retrospective cohort study
medicine.disease
Surgery
statin therapy
Spain
Estatines (Medicaments cardiovasculars)
Hydroxymethylglutaryl-CoA Reductase Inhibitors
business
Mace
Follow-Up Studies
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology, 2016, vol. 67, núm. 6, p. 630-640, Articles publicats (D-CM), DUGiDocs – Universitat de Girona, instname
- Accession number :
- edsair.doi.dedup.....31476ed887915653020b0aa68aa4b314