Non-Adherence to Statin Treatment in Older Patients with Peripheral Arterial Disease Depending on Persistence Status

The effectiveness of statins in secondary prevention of peripheral arterial disease (PAD) largely depends on patients’ adherence to treatment. The aims of our study were: (a) to analyze non-adherence during the whole follow-up in persistent patients, and only during persistence for non-persistent patients; (b) to identify factors associated with non-adherence separately among persistent and non-persistent patients. A cohort of 8330 statin users aged ≥65 years, in whom PAD was newly diagnosed between January 2012–December 2012, included 5353 patients persistent with statin treatment, and 2977 subjects who became non-persistent during the 5-year follow-up. Non-adherence was defined using the proportion of days covered <80%. Patient- and statin-related characteristics associated with non-adherence were identified with binary logistic regression. A significantly higher proportion of non-adherent patients was found among non-persistent patients compared to persistent subjects (43.6% vs. 29.6%; p < 0.001). Associated with non-adherence in both persistent and non-persistent patients was high intensity statin treatment, while in non-persistent patients, it was employment and increasing number of medications. In patients with a poor adherence during their persistent period, an increased risk for discontinuation may be expected. However, there is also non-adherence among persistent patients. There are differences in factors associated with non-adherence depending on patients’ persistence.

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Relation between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease among Construction Workers

10.53350/pjmhs2115103473 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3473-3475

Author(s):

U. Sivakumar ◽

Rinku Garg ◽

Sunita Nighute

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Peripheral Arterial Disease ◽

Pulmonary Disease ◽

Arterial Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Risk Of Death ◽

Increased Risk ◽

Peripheral Arterial

Introduction: PAD was asymptomatic in a large proportion of COPD patients and was associated with more severe lung disease than in COPD subjects without PAD. Materials and Methods: This was a Cross-sectional study conducted at Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a Sample size of 130 patients. Results: The characteristics of the population for follow-up (n=130) are presented in table 1. The mean Mean±SD was 51.73±6.1 years. The prevalence of never smokers was 21.5%, former smokers were 51.5% and current smokers were 26.9%. In total, 41 out of 130 individuals (31.5%) had PAD based on an ABI of less than 0.6. A statistically significant association was found between COPD and newly diagnosed PAD during follow-up. The association between COPD and incident PAD was stronger (adjusted OR 1.91, 95% CI 1.14–3.21). Stratified analysis by smoking status revealed that the overall association between COPD and newly developed PAD was driven by the ever smoker group. Conclusion: Subjects with COPD have a higher risk of developing PAD. People with both COPD and PAD have a substantially increased risk of death. Consequently, early detection of PAD and preventive actions in people with COPD should receive more attention in clinical respiratory care. Keywords: Peripheral Arterial Disease, Chronic Obstructive Pulmonary Disease, Ankle-brachial index.

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Peripheral arterial disease diagnosis and management in primary care: a qualitative study

BJGP Open ◽

10.3399/bjgpopen19x101659 ◽

2019 ◽

Vol 3 (3) ◽

pp. bjgpopen19X101659 ◽

Cited By ~ 1

Author(s):

Jan Lecouturier ◽

Jason Scott ◽

Nikki Rousseau ◽

Gerard Stansby ◽

Andrew Sims ◽

...

Keyword(s):

Primary Care ◽

Qualitative Study ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Disease Diagnosis ◽

Diagnosis And Management ◽

Increased Risk ◽

Peripheral Arterial ◽

The Impact

BackgroundPatients diagnosed with peripheral arterial disease (PAD) are at an increased risk of coronary heart disease, stroke, heart attack, and PAD progression. If diagnosed early, cardiovascular risk factors can be treated and the risk of other cardiovascular diseases can be reduced. There are clear guidelines on PAD diagnosis and management, but little is known about the issues faced in primary care with regards adherence to these, and about the impact of these issues on patients.AimTo identify the issues for primary care health professionals (HPs) and patients in PAD diagnosis and management, and to explore the impact of these on HPs and PAD patients.Design & settingQualitative study conducted in a primary care setting in the North East of England. Data was collected between December 2014 and July 2017.MethodSemi-structured interviews and focus groups were conducted with PAD register patients (n = 17), practice nurses ([PNs], n = 17), district nurses (DNs], n = 20), tissue viability nurses (n = 21), and GPs (n = 21).ResultsHPs’ attitudes to PAD, difficulty accessing tests, and patient delays impacted upon diagnosis. Some HPs had a reactive approach to PAD identification. Patients lacked understanding about PAD and some reported a delay consulting their GP after the onset of PAD symptoms. After diagnosis, few were attending for regular GP follow-up.ConclusionPatient education about PAD symptoms and risks, and questioning about exercise tolerance, could address the problem of under-reporting. Annual reviews could provide an opportunity to probe for PAD symptoms and highlight those requiring further investigation. Improved information when PAD is diagnosed and, considering the propensity for patients to tolerate worsening symptoms, the introduction of annual follow-up (at minimum) is warranted.

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Factors Associated with Reinitiation of Statin Treatment in Older Patients with Peripheral Arterial Disease

Drugs & Aging ◽

10.1007/s40266-020-00772-z ◽

2020 ◽

Vol 37 (8) ◽

pp. 595-604

Author(s):

Martin Wawruch ◽

Gejza Wimmer ◽

Jan Murin ◽

Martina Paduchova ◽

Tomas Tesar ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Older Patients ◽

Arterial Disease ◽

Statin Treatment ◽

Factors Associated ◽

Peripheral Arterial

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Lipoprotein-associated phospholipase A2 and risk of incident peripheral arterial disease in a multi-ethnic cohort: The Multi-Ethnic Study of Atherosclerosis

Vascular Medicine ◽

10.1177/1358863x16671424 ◽

2016 ◽

Vol 22 (1) ◽

pp. 5-12 ◽

Cited By ~ 9

Author(s):

Parveen K Garg ◽

Neal W Jorgensen ◽

Robyn L McClelland ◽

Nancy S Jenny ◽

Michael H Criqui ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Significant Interaction ◽

Regression Models ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Logistic Regression Models ◽

Increased Risk ◽

Adjusted Logistic Regression ◽

Peripheral Arterial

Prospective studies supporting a relationship between elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) and incident peripheral arterial disease (PAD) are limited. We evaluated the association of Lp-PLA2 with incident PAD in a multi-ethnic cohort without clinical cardiovascular disease. A total of 4622 participants with measurement of Lp-PLA2 mass and Lp-PLA2 activity and an ankle–brachial index (ABI) between 0.9 and 1.4 were followed for the development of PAD (median follow-up = 9.3 years), defined as an ABI ⩽0.9 and decline from baseline ⩾0.15. There were 158 incident PAD events during follow-up. In adjusted logistic regression models, each higher standard deviation of both Lp-PLA2 activity and mass did not confer an increased risk of developing PAD [odds ratios, (95% confidence intervals)]: 0.92 (0.66–1.27) for Lp-PLA2 activity and 1.06 (0.85–1.34) for mass. Additionally, no significant interaction was found according to ethnicity: p=0.43 for Lp-PLA2 activity and p=0.55 for Lp-PLA2 mass. We found no evidence of an association between Lp-PLA2 and incident PAD.

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Increased apoB/apoA-I Ratio is Predictive of Peripheral Arterial Disease in Initially Healthy 58-Year-old Men during 8.9 Years of Follow-up

Angiology ◽

10.1177/0003319708324925 ◽

2008 ◽

Vol 60 (5) ◽

pp. 539-545 ◽

Cited By ~ 3

Author(s):

L. Johansson ◽

C. Schmidt

Keyword(s):

Peripheral Arterial Disease ◽

Femoral Artery ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Increased Risk ◽

Peripheral Arterial ◽

Old Men ◽

The City

The aim of the present study was to investigate, if increased levels of apoB/apoA-I ratios are associated with future peripheral arterial disease as measured by ankle-brachial index. Increased apoB/apoA-I levels are defined as 0.9, which has been suggested for men, and as 0.63, which has observed to be associated with plaques in the femoral artery. The study was performed in a cohort of initially clinically healthy 58-year-old men living in the city of Göteborg, Sweden. The group with an apoB/apoA-I ratio ≥0.9 had a significantly increased risk of having PAD during 8.9 years of follow-up than the group below that level (OR: 2.15 CI: 1.21 to 3.82, p < 0.01). When applying the lower apoB/apoA-I cut off, results showed that the group with a level >0.63 had more than a three-fold risk of future PAD compared to the group ≤0.63 (OR: 3.28 CI: 1.14 to 9.40, p < 0.05).

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Abstract P190: Younger Women With Peripheral Arterial Disease Are at Increased Risk of Depressive Symptoms

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap190 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

Kim G Smolderen ◽

John A Spertus ◽

Patrick W Vriens ◽

Steef Kranendonk ◽

Maria M Nooren ◽

...

Keyword(s):

Depressive Symptoms ◽

Peripheral Arterial Disease ◽

Age Groups ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Younger Women ◽

Increased Risk ◽

Gender And Age ◽

Peripheral Arterial

Objectives: Gender disparities, particularly among young women with cardiovascular disease, are a growing cause for concern. Depression is a prevalent and prognostically important comorbidity in peripheral arterial disease (PAD), but its prevalence has not been described as a function of gender and age. We compared depressive symptoms at the time of PAD diagnosis and 6 months later by gender and age. Methods: In this 2-center observational follow-up study, 444 Dutch outpatients with newly diagnosed PAD (32% females) completed the 10-item CES-D at baseline and 6 months later (significant depressive symptoms reflected by scores ≥4). Results: Initially, 33% of women <65 years had significant depressive symptoms, and 6 months later, 19% of the younger women without significant depressive symptoms at baseline developed them. These rates were much higher than other gender-age groups (range at baseline=11-16%, 6-month incidence=6-10%; P ≤.03). Adjusting for demographic and clinical factors, women <65 years experienced a 4-fold greater odds of baseline (OR=4.3 [95%CI 2.2-8.7]) and follow-up depressive symptoms (OR=4.1 [2.0-8.4]) as compared with men ≥65 years. Other gender-age groups were not at increased risk (Figure). Adjusting for changes in ankle-brachial index did not erradicate the increased risk in younger women (OR=3.5 [1.2-10.2]). Conclusions: Depressive symptoms are more common in younger women with PAD than in other gender-age groups, both at the time of diagnosis and 6 months later. To eradicate gender-based disparities in PAD, depression screening and monitoring in younger women may be an important direction for future research and intervention.

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Increased risk of developing peripheral artery disease in hemodialysis patients receiving statin treatments: a population-based cohort study in Taiwan

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfz251 ◽

2019 ◽

Vol 35 (10) ◽

pp. 1753-1760 ◽

Cited By ~ 1

Author(s):

Yueh-Han Hsu ◽

Fung-Chang Sung ◽

Chih-Hsin Muo ◽

Shao-Yuan Chuang ◽

Chun-Ming Chen ◽

...

Keyword(s):

Proportional Hazards ◽

Arterial Disease ◽

Statin Treatment ◽

Population Based ◽

Cox Proportional Hazards ◽

Moderate Intensity ◽

Increased Risk ◽

Artery Disease ◽

Peripheral Arterial

Abstract Background Few investigations have evaluated the influences on peripheral arterial disease (PAD) risk of statin treatment in hemodialysis (HD) subjects with hyperlipidemia (HL). Methods From the National Health Insurance Research Dataset, we identified 3658 HD patients with statin therapy for HL as the statin cohort, and then selected, by 1:1 propensity score matching, 3658 HD patients with HL but without statin use as the nonstatin cohort in 2000–07. The cohorts were followed through until the end of 2011. We used Cox proportional hazards regression analysis to assess the hazard ratio (HR) of PAD development. Results The average follow-up period was 4.18 years; the incident PAD risk was 1.35-fold greater in statin users than in nonusers (16.87 versus 12.46/1000 person-years), with an adjusted HR (aHR) of 1.34 for PAD [95% confidence interval (CI) 1.12–1.62]. The PAD risk increases were significant for patients receiving fluvastatin (aHR 1.88; 95% CI 1.12–3.14) and atorvastatin (aHR 1.60; 95% CI 1.24–2.08). The risk increased with higher annual average statin dosage (P for trend <0.0001); the risk was higher for those receiving moderate-intensity statin treatment. The sensitivity test revealed similar findings. Conclusions HD patients with HL on statin medication were at increased PAD risk, which increased with cumulative statin dosage. Thorough considerations are needed before prescribing statins to HD patients.

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Complex antithrombotic therapy and bleeding risk in patients with peripheral arterial disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.2396 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Tseng ◽

S Bhatt ◽

M Girardo ◽

D Liedl ◽

P Wennberg ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Triple Therapy ◽

Major Bleeding ◽

Antithrombotic Therapy ◽

Oral Anticoagulants ◽

Bleeding Risk ◽

Arterial Disease ◽

Risk Of Bleeding ◽

Increased Risk ◽

Peripheral Arterial

Abstract Introduction Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation. Methods All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding). Results In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding. Conclusion Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants. Funding Acknowledgement Type of funding source: None

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Extremely elevated lipoprotein (a) as an independent risk factor for peripheral arterial disease in large patient cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.2397 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.R Poudel ◽

S Kirana ◽

D Stoyanova ◽

K.P Mellwig ◽

D Hinse ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Arterial Disease ◽

P Value ◽

Lipoprotein A ◽

Large Patient ◽

Increased Risk ◽

Revascularization Therapy ◽

Peripheral Arterial

Abstract Background Elevated lipoprotein (a) [LP (a)] levels are an independent, genetic, and causal factor for cardiovascular disease and associated with myocardial infarction (MI). Although the association between circulating levels of lipoprotein(a) [Lp(a)] and risk of coronary artery disease (CAD) is well established, its role in risk of peripheral arterial disease (PAD) remains unclear. PAD affects over 236 million individuals and follows ischaemic heart disease (IHD) and cerebrovascular disease (CVD) as the third leading cause of atherosclerotic cardiovascular morbidity worldwide. LP (a) is genetically determined, stable throughout life and yet refractory to drug therapy. While 30 mg/dl is considered the upper normal value for LP (a) in central Europe, extremely high LP (a) levels (>150mg/dl) are rare in the general population. The aim of our study was to analyse the correlation between lipoprotein (a) [LP (a)] levels and an incidence of PAD in high-risk patients. Patients and methods We reviewed the LP (a) concentrations of 52.898 consecutive patients admitted to our cardiovascular center between January 2004 and December 2014. Of these, 579 patients had LP (a) levels above 150 mg/dl (mean 181.45±33.1mg/dl). In the control collective LP (a) was <30mg/dl (n=350). Other atherogenic risk factors in this group were HbA1c 6.58±1.65%, low density lipoprotein (LDL) 141.99±43.76 mg/dl, and body mass index 27.81±5.61. 54.40% were male, 26.07% were smokers, 93.2% had hypertension, and 24% had a family history of cardiovascular diseases. More than 82.6% were under statins. The mean glomerular filtration rate (GFR) was 69.13±24.8 ml/min [MDRD (Modification of Diet in Renal Disease)]. Results 45.00% (n=261) of the patients with LP (a) >150mg/dl had PAD. The prevalence of PAD in patients with LP (a) <30mg/dl in our control collective was 15.8%. (P- Value 0.001). Patients with LP (a) >150mg/dl had a significantly increased risk for PAD (Odds ratio 4.36, 95% CI 2.94–6.72, p: 0.001). 19.1% of patients were re-vascularized by percutaneous angioplasty (PTA) and 7.09% of patients had to undergo peripheral vascular bypass (PVB). Mean LP (a) level in patients with PAD was 182.6±31.61. Conclusion Elevated LP (a) levels above 150 mg/dl are associated with a significantly increased risk of PAD in our collective and it confirms our hypothesis. Over one fourth of these patients had severe PAD and requiring revascularization therapy. We need more prospective studies to confirm our findings. Funding Acknowledgement Type of funding source: None

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