Lipid-lowering therapy in patients with peripheral arterial disease: are guidelines being met?

Evidence-based medical treatment of peripheral arterial disease: A rapid review

ABSTRACT Introduction: Peripheral arterial disease (PAD) treatment guidelines recommend the use of statins and antiplatelets in all PAD patients to reduce adverse cardiovascular and limb-related outcomes. In addition, hypertension and diabetes should be treated to reach recommended targets. The aim of this rapid review was to evaluate the level of adherence to evidence-based medical therapy (EBMT) recommended by PAD treatment guidelines in the real-world setting. Methods: We searched PubMed and Embase using keywords, MeSH and Emtree terms related to the population, exposure and outcomes from their inception to 22 September 2020. We included randomised controlled trials, non-randomised studies, and observational studies reporting adherence to at least 1 of these 4 drug classes: (1) statins, (2) antiplatelets, (3) antihypertensives and (4) antidiabetic drugs. Non-English articles, abstracts, dissertations, animal studies and case reports or series were excluded. A narrative summary of the results was performed. Results: A total of 42 articles were included in the review. The adherence to lipid-lowering drugs/statins ranged from 23.5 to 92.0% and antiplatelets from 27.5 to 96.3%. Only 7 and 5 studies reported use of “any anti-hypertensive” and “any anti-diabetic” medications, respectively, and the proportion of the cohort treated were generally close to the proportion with hypertension and/or diabetes. Adherence in studies published in 2016–2020 ranged from 52.4–89.6% for lipid-lowering drugs and 66.2–96.3% for antiplatelets. Conclusion: EBMT adherence in PAD patients was highly variable and a substantial proportion in many settings were undertreated. There was also a notable lack of studies in Asian populations. Keywords: Evidence-practice gap, medication adherence, pharmacoepidemiology

Biomarkers of peripheral arterial disease

Atherosclerotic arterial occlusive disease affecting the lower extremities is also known as peripheral artery disease (PAD). This disorder affects 8 to 12 million individuals in the U.S. and is increasingly prevalent in Europe and Asia. Unfortunately, most patients are not diagnosed and are not optimally treated. A blood test for PAD, if sufficiently sensitive and specific, would be expected to improve recognition and treatment of these individuals. Even a biomarker panel of moderate sensitivity and specificity for PAD could refine risk stratification to select individuals for diagnostic vascular examination. Alternatively, biomarkers for PAD may be useful in determining prognosis, the risk for progression, or the response to therapy. Finally, the discovery of biomarkers associated with PAD may provide novel insights into the pathophysiology of PAD and new therapeutic avenues to pursue. Biomarkers may be derived from studies of the genome, transcriptome, proteome, or metabolome. The focus of this review is on proteomic biomarkers associated with PAD.

Incidence of and factors associated with achieving target lipid levels in patients with peripheral arterial disease

BACKGROUND

Patients with peripheral arterial disease (PAD) have increased mortality compared with patients without PAD. Coronary artery disease (CAD) accounts for almost 75% of deaths in PAD patients. Studies suggest that PAD is underdiagnosed and atherosclerotic risk factors undertreated when compared with CAD.

OBJECTIVE

To determine whether cholesterol guidelines are being met in patients with PAD and to determine whether any independent factors increase the likelihood of reaching goal low-density lipoprotein (LDL).

DESIGN

A retrospective chart review of subjects diagnosed with PAD in 2001 at 2 Veterans Affairs Medical Centers.

MEASUREMENTS

Univariate analysis compares baseline characteristics between those reaching goal and those who do not. Multivariate logistic regression analysis identified predictors of meeting LDL goal among PAD patients.

RESULTS

Of 315 patients, 62% reached goal LDL. Those more likely to reach goal were older, had hypertension, and a history of CAD and stroke. Positive predictors of LDL goal were age and CAD, while smoking was a negative predictor.

CONCLUSION

The majority of veterans with PAD received lipid-lowering medication and achieve goal LDL, but they are more likely to do so if they are older than 70 and have a history of CAD.