Abstract 008: Statin Use and Its Facility Level Variation in Patients With Peripheral Artery Disease: Insights From the Department of Veterans Affairs

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cameron L McBride ◽  
Julia Akaroyd ◽  
David J Ramsey ◽  
Vijay Nambi ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
High Intensity ◽  
Veterans Affairs ◽  
Prescribing Patterns ◽  
Level Variation ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Facility Level ◽  
Statin Use

Background: The 2013 ACC/AHA cholesterol guideline recommends high-intensity statin therapy in patients 75 years or younger and moderate-intensity statin therapy in patients > 75 years with atherosclerotic cardiovascular disease including those with peripheral artery disease (PAD). Statin prescribing patterns and their facility-level variation in patients with PAD are unknown. Methods: We examined the frequency and facility-level variation in the use of any and correct intensity of statins in patients with known PAD receiving primary care in 130 facilities across the Veterans Affairs (VA) health care system with or without concomitant ischemic heart disease (IHD) or ischemic cerebrovascular disease (ICVD). We calculated the median rate ratios (MRR) adjusted for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns for comparable patients. Results: Among 194,151 patients with PAD, 88,905 (45.8%) had PAD without IHD (with or without ICVD) and 70,404 (36.3%) had PAD without IHD or ICVD. Rates of statin use in the entire PAD cohort, patients with PAD without IHD and PAD alone were 79.0%, 69.1% and 66.3%, respectively. Median facility-level rates of statin use were 78.9% (IQR 75.9-81.5), 69.2% (65.4-72.6) and 66.4% (62.6-70.1), respectively. Correct intensity statins were prescribed among 40.9% for the entire PAD cohort, 28.9% of those with PAD without IHD, and 26.4% of those with PAD alone. Median facility-level rate of correct statin intensity use in all PAD patients was 40.1% (36.4-44.2), 27.8% (24.1-32.4) for patients with PAD without IHD and 25.3% (10.8-29.7) in patients with PAD alone. Calculated MRRs reflected a 20-22% variation among two facilities in treating identical PAD patients with statin therapy and a 24-28% variation in treating identical patients with correct statin intensity (Table). Conclusions: The use of statin and especially correct statin intensity is suboptimal in PAD patients, especially in PAD patients without concomitant IHD or ICVD. There is a significant facility-level variation in the receipt of guideline directed statin therapy in PAD patients. Interventions are needed to improve guideline directed moderate to high-intensity statin use and to reduce variation in care in this high-risk group.

Abstract 195: Statin Use and Its Facility Level Variation in Patients With Ischemic Cerebrovascular Disease: Insights From the Department of Veterans Affairs

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Cameron L McBride ◽  
Julia Akaroyd ◽  
David J Ramsey ◽  
Vijay Nambi ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Cerebrovascular Disease ◽  
Statin Therapy ◽  
High Intensity ◽  
Veterans Affairs ◽  
Prescribing Patterns ◽  
Moderate Intensity ◽  
Level Variation ◽  
Ischemic Cerebrovascular Disease ◽  
Facility Level ◽  
Statin Use

Background: The 2013 ACC/AHA cholesterol guideline recommends high-intensity statin therapy in patients 75 or younger and moderate-intensity statins in patients > 75 years with atherosclerotic cardiovascular disease including those with ischemic cerebrovascular disease (ICVD). Statin prescribing patterns and their facility-level variation in patients with ICVD are unknown. Methods: We examined the frequency and facility-level variation in the use of any and correct intensity statins in patients with ICVD (ischemic stroke or carotid arterial disease) who received primary care in 130 facilities across the Veterans Affairs (VA) health care system with or without concomitant ischemic heart disease (IHD) or peripheral artery disease (PAD). We then calculated median rate ratios (MRR) adjusted for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns for comparable patients. Results: Among 339,771 ICVD patients, 182,231 (53.6%) had ICVD without IHD (with or without PAD) and 163,730 (48.2%) had ICVD without IHD or PAD. Rates of statin use in the entire ICVD group, patients with ICVD without IHD, and ICVD alone were 78.1%, 70.9% and 69.9%, respectively. Median facility-level rates of any statin use were 78.1% (IQR 75.5-80.7), 70.7% (67.9-73.8) and 69.9% (66.9-73.1), respectively. Correct intensity statins were prescribed among 40.2% of the entire ICVD group, 30.5% with ICVD without IHD, and 29.6% with ICVD alone. Median facility-level rate of correct statin use in all ICVD patients was 39.1% (35.8-43.9), 29.9% (26.0-34.6) for patients with ICVD without IHD and 29.0% (25.4-33.7) in those with ICVD alone.Calculated MRRs reflect approximately 22% variation among two facilities treating two identical ICVD patients with statin therapy and a 27-28% variation in identical ICVD patients for correct statin intensity (Table). Conclusions: The use of statin and especially guideline-recommended statin intensity is suboptimal in ICVD patients, especially patients without concomitant IHD or PAD. There is significant facility-level variation in receipt of guideline directed statin therapy in ICVD patients. Interventions are needed to improve guideline directed moderate to high-intensity statin use and reduce variation in care in this high risk group.

scholarly journals Statin prescription rates and their facility-level variation in patients with peripheral artery disease and ischemic cerebrovascular disease: Insights from the Department of Veterans Affairs

2018 ◽  
Vol 23 (3) ◽  
pp. 232-240 ◽  
Author(s):  
Cameron L McBride ◽  
Julia M Akeroyd ◽  
David J Ramsey ◽  
Vijay Nambi ◽  
Khurram Nasir ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischemic Heart Disease ◽  
Statin Therapy ◽  
Veterans Affairs ◽  
Level Variation ◽  
Peripheral Artery ◽  
Ischemic Cerebrovascular Disease ◽  
Statin Prescription ◽  
Artery Disease ◽  
Facility Level

The 2013 American College of Cardiology/American Heart Association cholesterol guideline recommends moderate to high-intensity statin therapy in patients with peripheral artery disease (PAD) and ischemic cerebrovascular disease (ICVD). We examined frequency and facility-level variation in any statin prescription and in guideline-concordant statin prescriptions in patients with PAD and ICVD receiving primary care in 130 facilities across the Veterans Affairs (VA) health care system between October 2013 and September 2014. Guideline-concordant statin intensity was defined as the prescription of high-intensity statins in patients with PAD or ICVD ≤75 years and at least moderate-intensity statins in those >75 years. We calculated median rate ratios (MRR) after adjusting for patient demographic factors to assess the magnitude of facility-level variation in statin prescribing patterns independent of patient characteristics. Among 194,151 PAD patients, 153,438 patients (79.0%) were prescribed any statin and 79,435 (40.9%) were prescribed a guideline-concordant intensity of statin. PAD patients without ischemic heart disease were prescribed any statin and a guideline-concordant intensity of statin therapy less frequently (69.1% and 28.9%, respectively). Among 339,771 ICVD patients, 265,491 (78.1%) were prescribed any statin and 136,430 (40.2%) were prescribed a guideline-concordant intensity of statin. ICVD patients without ischemic heart disease were prescribed any statin and a guideline-concordant intensity of statin less frequently (70.9% and 30.5%, respectively). MRRs for both PAD and ICVD patients demonstrated a 20% and 28% variation among two facilities in treating two identical patients with statin therapy and guideline-concordant intensity of statin therapy, respectively. The prescription of statins, especially guideline-recommended intensity of statin therapy, is suboptimal in PAD and ICVD patients, with significant facility-level variation not explained by patient-level factors.

P652Lower use of statins among patients with peripheral artery disease compared with those with coronary heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L D Colantonio ◽  
Y Dai ◽  
D Hubbard ◽  
R S Rosenson ◽  
T M Brown ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Peripheral Artery Disease ◽  
High Intensity ◽  
Prevalence Ratio ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease ◽  
Multivariable Adjustment ◽  
Statin Use

Abstract Background Adults with atherosclerotic cardiovascular disease are recommended to take a statin to reduce their risk for future cardiovascular events. Prior studies suggest that statins are being taken by most adults with coronary heart disease (CHD). However, there are few data on the use of statins among adults with peripheral artery disease (PAD). Purpose To compare the use of statins among US adults with a history of PAD versus those with a history of CHD. Methods We conducted a retrospective cohort study among US adults ≥19 years of age with commercial or government health insurance who had a history of CHD or PAD as of December 31, 2014 (n=1,006,451, mean age 63 years, 47% male). We used pharmacy claims between January 1 and December 31, 2014 to identify use of any statin and of a high-intensity statin (i.e., atorvastatin 40–80 mg, rosuvastatin 20–40 mg, simvastatin 80 mg). Patients with a history of CHD without PAD (CHD only), both CHD and PAD, and PAD without CHD (PAD only) were analysed. Prevalence ratios for use of any statin and a high-intensity statin among those taking a statin were calculated after multivariable adjustment for sociodemographics and cardiovascular risk factors. Results Overall, 69.1% of patients included in the current analysis had CHD only, 21.4% had both CHD and PAD, and 9.5% had PAD only. Overall, 66.0%, 68.2% and 47.5% of patients with CHD only, CHD and PAD, and PAD only were taking a statin. After multivariable adjustment and compared to patients with CHD only, the prevalence ratio for statin use was 1.02 (95% CI 1.01, 1.02) for those with both CHD and PAD and 0.82 (95% CI 0.82, 0.83) for those with PAD only. Among patients taking a statin, 29.4% of those with CHD only, 28.6% of those with both CHD and PAD, and 17.3% of those with PAD only were taking a high-intensity dosage. Compared to patients with CHD only, the multivariable adjusted prevalence ratio for taking a high-intensity dosage was 1.05 (95% CI 1.04, 1.06) for those with both CHD and PAD and 0.71 (95% CI 0.70, 0.73) for those with PAD only. Conclusion Adults with PAD receive less intensive statin therapy compared with their counterparts who have CHD. Interventions aimed to increase statin use among patients with PAD are warranted. Acknowledgement/Funding This study was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA, USA).

scholarly journals Efficacy and Safety of Vorapaxar by Intensity of Background Lipid‐Lowering Therapy in Patients With Peripheral Artery Disease: Insights From the TRA2P‐TIMI 50 Trial

2021 ◽  
Author(s):  
Ian C. Gilchrist ◽  
David A. Morrow ◽  
Mark A. Creager ◽  
Jeffrey W. Olin ◽  
Benjamin M. Scirica ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Peripheral Artery ◽  
Thrombotic Risk ◽  
Increased Risk ◽  
Artery Disease ◽  
Ischemic Events ◽  
Statin Use

Background Patients with peripheral artery disease are at increased risk of both major adverse cardiovascular events (MACEs) and limb events. The pathobiology of limb events is likely multifactorial. Observational studies suggest a benefit of statin therapy for reducing the risk of limb ischemic events while randomized trials demonstrate a benefit with more potent antithrombotic therapies, particularly those targeting thrombin. Whether the effects of these therapeutic pathways are independent and complementary is not known. Methods and Results The TRA 2°P‐TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events–Thrombolysis in Myocardial Infarction 50) trial demonstrated that vorapaxar significantly reduced MACEs and limb events. The purpose of the current analysis was to evaluate the association of statin use and intensity and the occurrence of MACEs and limb events in 5845 patients with symptomatic peripheral artery disease randomized in TRA 2°P‐TIMI 50 and then to understand whether statin use modified the benefits of vorapaxar for MACEs or limb ischemic events. We found that statin therapy was associated with significantly lower risk of MACEs (hazard ratio [HR], 0.77; 95% CI, 0.66–0.89; P <0.001) and limb ischemic events (HR, 0.73; 95% CI, 0.60–0.89; P =0.002). The benefit of vorapaxar for reducing MACEs and limb events was consistent regardless of background statin ( P ‐interaction=0.715 and 0.073, respectively). Event rates were lowest in patients receiving the combination of statin therapy and vorapaxar. Conclusions In conclusion, statin use and intensity is associated with significantly lower rates of MACEs and limb ischemic events. Thrombin inhibition with vorapaxar is effective regardless of background statin therapy. These results suggest that targeting both lipid and thrombotic risk in peripheral artery disease is necessary in order to optimize outcomes.

scholarly journals High‐Intensity Statin Therapy Is Associated With Improved Survival in Patients With Peripheral Artery Disease

2017 ◽  
Vol 6 (7) ◽  
Author(s):  
T. Raymond Foley ◽  
Gagan D. Singh ◽  
Damianos G. Kokkinidis ◽  
Ho‐Hin K. Choy ◽  
Tai H. Pham ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
High Intensity ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Trends in statin utilization among adults with severe peripheral artery disease including critical limb ischemia in an integrated healthcare delivery system

2019 ◽  
Vol 25 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Kristi Reynolds ◽  
Katherine E Mues ◽  
Teresa N Harrison ◽  
Lei Qian ◽  
Songyue Chen ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
Critical Limb Ischemia ◽  
Healthcare Delivery ◽  
Limb Ischemia ◽  
Peripheral Artery ◽  
Healthcare Delivery System ◽  
Integrated Healthcare ◽  
Artery Disease ◽  
Statin Use

Evidence suggests that statin therapy in patients with peripheral artery disease (PAD) is beneficial yet use remains suboptimal. We examined trends in statin use, intensity, and discontinuation among adults aged ⩾ 40 years with incident severe PAD and a subset with critical limb ischemia (CLI) between 2002 and 2015 within an integrated healthcare delivery system. Discontinuation of statin therapy was defined as the first 90-day gap in treatment within 1 year following PAD diagnosis. We identified 11,059 patients with incident severe PAD: 31.1% ( n = 3442) with CLI and 68.9% ( n = 7617) without CLI. Mean (SD) age was 68.6 (11.3) years, 60.5% were male, 54.2% white, 23.2% Hispanic, and 16.2% black. Statin use in the year before diagnosis increased from 50.4% in 2002 to 66.0% in 2015 (CLI: 43.7% to 68.0%; without CLI: 53.1% to 64.2%, respectively). The proportion of patients on high-intensity statins increased from 7.3% in 2002 to 41.9% in 2015 (CLI: 7.2% to 39.4%; without CLI: 7.4% to 44.2%, respectively). Of the 40.5% ( n = 4481) who were not on a statin in the year before diagnosis, 13.5% ( n = 607) newly initiated therapy within 1 month (CLI: 10.1% ( n = 150); without CLI: 15.3% ( n = 457)). Following diagnosis, 12.5% ( n = 660) discontinued statin therapy within 1 year (CLI: 15.5% ( n = 202); without CLI: 11.5% ( n = 458)). Although use of statins increased from 2002 to 2015, a substantial proportion of the overall PAD and CLI subpopulation remained untreated with statins, representing a significant treatment gap in a population at high risk for cardiovascular events and adverse limb outcomes.

scholarly journals Influence of Peripheral Artery Disease and Statin Therapy on Apolipoprotein Profiles

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Andrew W. Gardner ◽  
Petar Alaupovic ◽  
Donald E. Parker ◽  
Polly S. Montgomery ◽  
Omar L. Esponda ◽  
...  
Keyword(s):  
Physical Activity ◽  
Myocardial Infarction ◽  
Statin Therapy ◽  
Peripheral Artery Disease ◽  
Apolipoprotein B ◽  
Ldl Cholesterol ◽  
Risk Profile ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Plasma Apolipoprotein

Apolipoprotein B is a stronger predictor of myocardial infarction than LDL cholesterol, and it is inversely related to physical activity and modifiable with exercise training. As such, apolipoprotein measures may be of particular relevance for subjects with PAD and claudication. We compared plasma apolipoprotein profiles in 29 subjects with peripheral artery disease (PAD) and intermittent claudication and in 39 control subjects. Furthermore, we compared the plasma apolipoprotein profiles of subjects with PAD either treated (n=17) or untreated (n=12) with statin medications. For the apolipoprotein subparticle analyses, subjects with PAD had higher age-adjusted Lp-B:C (P<0.05) and lower values of Lp-A-I:A-II (P<0.05) than controls. The PAD group taking statins had lower age-adjusted values for apoB (P<0.05), Lp-A-II:B:C:D:E (P<0.05), Lp-B:E + Lp-B:C:E (P<0.05), Lp-B:C (P<0.05), and Lp-A-I (P<0.05) than the untreated PAD group. Subjects with PAD have impaired apolipoprotein profiles than controls, characterized by Lp-B:C and Lp-A-I:A-II. Furthermore, subjects with PAD on statin medications have a more favorable risk profile, particularly noted in multiple apolipoprotein subparticles. The efficacy of statin therapy to improve cardiovascular risk appears more evident in the apolipoprotein sub-particle profile than in the more traditional lipid profile of subjects with PAD and claudication. This trial is registered with ClinicalTrials.govNCT00618670.

scholarly journals Atherosclerotic Risk and Statin Use Among Patients With Peripheral Artery Disease

2020 ◽  
Vol 76 (3) ◽  
pp. 251-264 ◽  
Author(s):  
Lisandro D. Colantonio ◽  
Demetria Hubbard ◽  
Keri L. Monda ◽  
Katherine E. Mues ◽  
Lei Huang ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease ◽  
Statin Use
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