With commentary from lead author Shipra Arya, M.D., S.M., assistant professor in the division of vascular surgery at Emory University School of Medicine in Atlanta, Georgia.
People with peripheral artery disease (PAD) – including many with diabetes – who took cholesterol-lowering statin drugs had a 22-33 percent lower risk of losing a leg or other limb to amputation in a new Emory University study. Statin users were also less likely than non-users to die during the 5-year study, presented Friday at the American Heart Association’s Arteriosclerosis, Thrombosis and Vascular Biology/Peripheral Vascular Disease 2016 Scientific Sessions in Nashville, TN.
Researchers used information from the U.S. Veterans Administration database to track the health of 208,275 military veterans who had PAD – the often-painful and dangerous narrowing of arteries that supply blood to the legs, stomach, arms and head due to a build-up of fatty plaque. Participants’ average age was 67 and nearly all were men. Over 5.2 years, 17,643 had amputations and 99,951 died – but some medications made a difference.
Those taking statins, which are often prescribed for PAD, got some protection, reports lead author Shipra Arya, M.D., S.M., an assistant professor in the division of vascular surgery at Emory University School of Medicine in Atlanta, Georgia. Those who took high-dose statins were 33% less likely to have an amputation and 29% less likely to die compared to those not taking statins. Those who took low- to moderate-dose statins had a 22 percent lower risk for amputation and death. One-quarter of the study participants did not take a statin, even though the drugs are recommended to reduce cholesterol levels and symptoms like pain and difficulty walking in people with PAD and to cut risk for serious, related risks such as heart attacks and strokes.
“PAD is the next cardiovascular epidemic,” Dr. Arya told EndocrineWeb. “It is characterized by the same arterial stiffening and plaque formation as heart disease. When blood flow to the legs is compromised due to these plaques/cholesterol deposits, it can lead to amputations. Statins lower cholesterol levels and provide stability to these plaques so they don’t compromise blood flow to the legs. Therefore it can prevent amputations.”
“Ours is one of the largest population-based studies on PAD and suggests patients who have been diagnosed with PAD should be considered for placement on high dose statins upon diagnosis if they can tolerate it, along with other medical management, including smoking cessation, antiplatelet therapy and a walking program,” she adds.
Dr. Arya told EndocrineWeb that 47% of the study participants had diabetes. They faced a two- to three-fold higher risk for amputation than those without diabetes. “We included diabetics in our study and statins have a protective effect on death – about a 20% reduction of risk -- and on amputations – about a 30% reduction of risk -- even after controlling for their diabetic status,” she says.
PAD is a special health concern for people with type 1 and type 2 diabetes. People with type 2 diabetes have a three-fold higher risk for PAD than people without blood-sugar problems. Higher blood sugar means higher risk: Every one point increase in A1c boosts risk for a PAD-related amputation 44 percent for people with type 2 and 18% for people with type 1 diabetes, according to a 2010 review from the UK’s Cambridge University Foundation Hospital Trust. Diabetes promotes the build-up of gunky plaque in artery walls and can also trigger plaque break-ups that can clog arteries even more. As a result, people with diabetes are also more likely to have PAD symptoms, such as pain while walking.1
Endocrinologist Alan L. Rubin, MD, who was not involved in the study, told EndocrineWeb that the study’s large size and fairly long length of time provide significant new evidence in favor of prescribing statins for people with type 2 diabetes and PAD. “Earlier studies, as far back as 2010, have shown benefits but those studies are much smaller,” notes Dr. Rubin, author of Diabetes for Dummies and Prediabetes for Dummies. “This study fits in perfectly with what we already knew about statins. Its massive size and excellent results will be appreciated in the medical community as physicians and their patients make treatment decisions about peripheral artery disease.”
1. Amjad Al Mahameed: Peripheral Arterial Disease. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/cardiology/peripheral-arterial-disease/. Published: January 2009. Accessed May 5, 2016
2. Adler AI, Erqou S, Lima TA, Robinson AH: Association between glycated haemoglobin and the risk of lower extremity amputation in patients with diabetes mellitus: review and meta-analysis. Diabetologia. 2010;53:840–849 http://www.ncbi.nlm.nih.gov/pubmed/20127309?dopt=Abstract. Accessed May 6, 2016.
3. Type 2 Diabetes Center. www.diabeticlifestyle.com http://www.diabeticlifestyle.com/type-2-diabetes/center. Accessed May 6, 2016.
1. Steven P. Marso, MD, FACC,* William R. Hiatt, MD†Peripheral Arterial Disease in Patients With Diabetes. J Am Coll Cardiol 2006;47:921–9. http://content.onlinejacc.org/article.aspx?articleid=1137354#tab1