Never too late to start taking statins for peripheral arterial disease – study

It is never too late to start taking statins for clogged leg arteries, scientists say.

Statins are linked with reduced mortality in patients with peripheral arterial disease (PAD), even when started late after diagnosis, new research indicates.

But the study presented at the European Society of Cardiology Congress, suggests patients who stop the drug are at similar risk to those who never start.

The research shows the importance of starting and adhering to lifelong medication, preferably at a high dose, scientists say.

Study author Dr Jorn Dopheide of Bern University Hospital, Switzerland, said: “The study shows that adherence to statins is essential for the best prognosis.

“We also show that it is never too late to start medication and benefit from it.

“On top of that, it is crucial not to reduce the dose because LDL cholesterol levels rise again, thus increasing the overall risk on top of the residual risk for further events.”

Globally around 200 million people have PAD, a condition in which arteries in the legs are clogged.

It restricts blood flow to the legs and raises the chances of stroke and heart attack.

Around 30% of patients have pain and cramping in their legs when they walk, while others have gangrene in the feet due to poor circulation.

Statins are recommended for all patients with PAD, together with stopping smoking, exercise, healthy diet, and weight loss.

They reduce the risk of stroke and heart attack by reducing low-density lipoprotein (LDL) cholesterol, which causes blocked arteries.

According to the research, over the past five years only 57% of patients in Europe took the medication as directed.

In 2016 to 2017, only one-third of patients on statins reached the LDL cholesterol target.

Researchers looked at whether adherence to statin therapy influenced survival in patients with symptomatic PAD.

The study involved 691 patients admitted to hospital between 2010 and 2017 and followed-up for a median of 50 months.

At the beginning of the study, 73% of patients were on statins, increasing to 81% at the 50-month follow-up.

Between the two time periods, the dose of the drug also increased, which was paralleled by a significant drop in LDL cholesterol.

Patients who stopped taking a statin had a similar mortality rate (33%) to those who never took the drug (34%).

Researchers say sticking to statins throughout the 50 months was linked with a 20% rate of death.

Taking high-dose statins throughout the study was linked with the lowest mortality rate (10%), while reducing the dosage during the study was related to the highest death rate (43%).

Dr Dopheide concluded: “All PAD patients should take statins, preferably very potent statins, like rosuvastatin 40mg or atorvastatin 80mg, or at the highest tolerable dose.

“In the rare case of statin intolerance, which was around 2% in our study, alternative lipid lowering therapies must be considered.”