PMID- 28506476 OWN - NLM STAT- MEDLINE DCOM- 20170731 LR - 20240316 IS - 1097-6809 (Electronic) IS - 0741-5214 (Print) IS - 0741-5214 (Linking) VI - 66 IP - 2 DP - 2017 Aug TI - Adherence to lipid management guidelines is associated with lower mortality and major adverse limb events in patients undergoing revascularization for chronic limb-threatening ischemia. PG - 572-578 LID - S0741-5214(17)30937-0 [pii] LID - 10.1016/j.jvs.2017.03.416 [doi] AB - OBJECTIVE: The 2013 American College of Cardiology/American Heart Association lipid management guidelines recommend high-intensity statins for all patients 75 years old without contraindications or on dialysis, but these recommendations are based primarily on coronary and stroke data. We aimed to validate these guidelines in patients with CLTI and to assess current adherence to these recommendations. METHODS: We identified all patients with CLTI who underwent first-time revascularization (endovascular or surgical) at Beth Israel Deaconess Medical Center from 2005 to 2014. Patients were classified as taking high-intensity, moderate-intensity, low-intensity, or no statin postoperatively. Outcomes included death and major adverse limb event (MALE). Propensity scores were calculated for the probability of receiving guideline-recommended intensity of statin therapy to account for nonrandom assignment of treatments. Cox regression models were constructed and adjusted for the propensity scores and further adjusted for strong potential confounders. RESULTS: After excluding patients on hemodialysis (n = 252), we identified 1019 limbs from 931 patients with a median follow-up of 380 days. Patients discharged on the recommended statin intensity had higher rates of preoperative statin use, coronary artery disease, chronic kidney disease, stroke, atrial fibrillation, congestive heart failure, and coronary artery bypass grafting; they had lower smoking rates and were less likely to be ambulatory preoperatively. Overall, only 35% were taking the recommended statin dosage: 55% of those >75 years old and 20% of those 75 years old and 75 years old, moderate-intensity statin therapy was associated with lower rates of death and MALE compared with high-intensity therapy but did not reach statistical significance. CONCLUSIONS: Use of the recommended intensity of statin therapy in compliance with 2013 American College of Cardiology/American Heart Association lipid management guidelines is associated with significantly improved survival and lower MALE rate in patients undergoing revascularization for CLTI. Adherence to current guidelines is an appealing target for quality improvement. CI - Copyright (c) 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved. FAU - O'Donnell, Thomas F X AU - O'Donnell TFX AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. FAU - Deery, Sarah E AU - Deery SE AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. FAU - Darling, Jeremy D AU - Darling JD AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. FAU - Shean, Katie E AU - Shean KE AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. FAU - Mittleman, Murray A AU - Mittleman MA AD - Cardiovascular Epidemiology Research Unit, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass. FAU - Yee, Gabrielle N AU - Yee GN AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. FAU - Dernbach, Matthew R AU - Dernbach MR AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. FAU - Schermerhorn, Marc L AU - Schermerhorn ML AD - Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, Mass. Electronic address: mscherm@bidmc.harvard.edu. LA - eng GR - T32 HL007734/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Validation Study DEP - 20170512 PL - United States TA - J Vasc Surg JT - Journal of vascular surgery JID - 8407742 RN - 0 (Biomarkers) RN - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors) RN - 0 (Lipids) SB - IM MH - Age Factors MH - Aged MH - Aged, 80 and over MH - Biomarkers/blood MH - Chi-Square Distribution MH - Chronic Disease MH - Dyslipidemias/blood/complications/*drug therapy/mortality MH - *Endovascular Procedures/adverse effects/mortality MH - Female MH - Guideline Adherence/standards/trends MH - Humans MH - Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects/*therapeutic use MH - Ischemia/etiology/mortality/*surgery MH - Lipids/*blood MH - Male MH - Middle Aged MH - Multivariate Analysis MH - Peripheral Arterial Disease/etiology/mortality/*surgery MH - *Practice Guidelines as Topic/standards MH - *Practice Patterns, Physicians'/standards/trends MH - Propensity Score MH - Proportional Hazards Models MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Time Factors MH - Treatment Outcome MH - *Vascular Surgical Procedures/adverse effects/mortality PMC - PMC5843377 MID - NIHMS866802 EDAT- 2017/05/17 06:00 MHDA- 2017/08/02 06:00 PMCR- 2018/08/01 CRDT- 2017/05/17 06:00 PHST- 2016/11/18 00:00 [received] PHST- 2017/03/03 00:00 [accepted] PHST- 2017/05/17 06:00 [pubmed] PHST- 2017/08/02 06:00 [medline] PHST- 2017/05/17 06:00 [entrez] PHST- 2018/08/01 00:00 [pmc-release] AID - S0741-5214(17)30937-0 [pii] AID - 10.1016/j.jvs.2017.03.416 [doi] PST - ppublish SO - J Vasc Surg. 2017 Aug;66(2):572-578. doi: 10.1016/j.jvs.2017.03.416. Epub 2017 May 12.