Efficacy of a Guideline-Recommended Risk-Reduction Program to Improve Cardiovascular and Limb Outcomes in Patients With Peripheral Arterial Disease

Hussain, Mohamad A.; Al‐Omran, Mohammed; Mamdani, Muhammad; Eisenberg, Naomi; Premji, Azra; Saldanha, Lisa; Wang, Xuesong; Verma, Subodh; Lindsay, Thomas F.

doi:10.1001/jamasurg.2016.0415

Cited by 68 publications

(17 citation statements)

References 35 publications

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“…This highlights the importance of effective guideline-recommended risk-reduction programs for patients with peripheral artery disease, which may reduce the risk of adverse limb outcomes. 33 Second, the results support the formulation of public health campaigns against peripheral artery disease, especially in light of the large knowledge gap present within the Canadian public. 34 Last, this study highlights the need for the development of effective outpatient quality-improvement initiatives for patients undergoing vascular surgery stipulated for the Canadian health care system, particularly targeting early wound assessment and management after surgery.…”

Section: Discussionmentioning

confidence: 56%

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

Syed

Hussain

Khoshhal

et al. 2018

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Section: Discussionmentioning

confidence: 56%

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

Syed

Hussain

Khoshhal

et al. 2018

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“…Clearly, optimal secondary preventative therapy is crucial. Guideline-directed risk factor management is associated with improved outcomes [ 33 ]. More speculatively, an LLAC score in the highest quartile may identify some individuals with either significant undiagnosed coronary disease or a group for whom medical management of coronary disease is perhaps insufficient.…”

Section: Discussionmentioning

confidence: 99%

Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity

et al. 2017

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AimsThe association of coronary arterial calcification with cardiovascular morbidity and mortality is well-recognized. Lower limb arterial calcification (LLAC) is common in PAD but its impact on subsequent health is poorly described. We aimed to determine the association between a LLAC score and subsequent cardiovascular events in patients with symptomatic peripheral arterial disease (PAD).MethodsLLAC scoring, and the established Bollinger score, were derived from a database of unenhanced CT scans, from patients presenting with symptomatic PAD. We determined the association between these scores outcomes. The primary outcome was combined cardiac mortality and morbidity (CM/M) with a secondary outcome of all-cause mortality.Results220 patients (66% male; median age 69 years) were included with follow-up for a median 46 [IQR 31–64] months. Median total LLAC scores were higher in those patients suffering a primary outcome (6831 vs. 1652; p = 0.012). Diabetes mellitus (p = 0.039), ischaemic heart disease (p = 0.028), chronic kidney disease (p = 0.026) and all-cause mortality (p = 0.012) were more common in patients in the highest quartile of LLAC scores. The area under the curve of the receiver operator curve for the LLAC score was greater (0.929: 95% CI [0.884–0.974]) than for the Bollinger score (0.824: 95% CI [0.758–0.890]) for the primary outcome. A LLAC score ≥ 4400 had the best diagnostic accuracy to determine the outcome measure.ConclusionThis is the largest study to investigate links between lower limb arterial calcification and cardiovascular events in symptomatic PAD. We describe a straightforward, reproducible, CT-derived measure of calcification—the LLAC score.

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“…Several studies have reported underutilization of established risk‐reduction therapies such as statins for peripheral artery disease relative to coronary artery disease,6, 7, 8 which may lead to poor cardiovascular and limb outcomes 9. Nevertheless, few data exist on the utilization of statin therapy among patients with carotid artery disease.…”

Section: Introductionmentioning

confidence: 99%

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Hussain

Saposnik

Raju

et al. 2018

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BackgroundStatins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization.Methods and ResultsIn this population‐level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002–2014). The primary outcome was a composite of 1‐year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five‐year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate‐ or high‐dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1‐year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70–0.83). Patients who were on persistent long‐term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71–0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose.ConclusionsContinuous statin therapy was associated with a 25% lower risk of long‐term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.

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Efficacy of a Guideline-Recommended Risk-Reduction Program to Improve Cardiovascular and Limb Outcomes in Patients With Peripheral Arterial Disease

Cited by 68 publications

References 35 publications

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

Thirty-day hospital readmission and emergency department visits after vascular surgery: a Canadian prospective cohort study

Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

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