Drug Classes Cut Deaths in Peripheral Arterial Disease

BY MITCHEL L. ZOLER

DALLAS -- Treatment with each of four drug classes--statins, b-blockers, aspirin, and ACE inhibitors--was associated with significant cuts in mortality in patients with peripheral artery disease during an average follow-up of 8 years, Dr. Harm H. Feringa reported at the annual scientific sessions of the American Heart Association.

"Patients with peripheral artery disease have, by definition, coronary artery disease. A patient with proven coronary artery disease should get" these drugs, commented Dr. Don Poldermans, a coinvestigator on the study and professor of medicine at Erasmus University in Rotterdam, the Netherlands. "You need to find a reason not to give these drugs to patients with peripheral artery disease," he said.

The analysis reviewed 2,420 consecutive patients with peripheral artery disease seen at Erasmus University during 1983-2004. Their average age was 64 years, and 72% were men. The average ankle-brachial index was 0.58. At baseline, 19% of the patients were treated with a statin, 25% were treated with a b-blocker, 22% were on aspirin, and 26% received an ACE inhibitor.

During follow-up, 1,067 (44%) of the patients died, according to data from civil registry records. The investigators performed a multivariate analysis to determine the relative risk for all-cause mortality associated with various clinical measures and with drug treatment.

The most powerful clinical association for death was renal failure, which increased mortality by 3.3 times. Hypercholesterolemia boosted mortality by 77%, a history of heart failure was linked with a 73% increased risk, and age of more than 70 years was linked with a 68% increased risk of death.

Treatment with a statin at baseline was linked with a 54% reduced risk of death. Treatment with a ?-blocker was associated with a 32% reduced risk, aspirin was linked with a 28% reduced risk, and treatment with an ACE inhibitor was linked with a 20% reduced risk of death. All of these associations were statistically significant, said Dr. Feringa, an Erasmus University physician.

Treatment at baseline with a calcium channel blocker, warfarin (Coumadin), a diuretic, or a nitrate was not significantly associated with a reduced risk of death.

So far, the analysis has not looked for possible interactions between treatment with statins, b-blockers, aspirin, and ACE inhibitors.

During the period studied, use of all four drug classes increased. During 1983-1987, statins, b-blockers, aspirin, and ACE inhibitors were used by 13%, 17%, 15%, and 12% of all patients, respectively. During 2000-2004, the prescription rates for these drugs were 32%, 40%, 27%, and 30%, respectively, Dr. Feringa said.

"This is a very important presentation since it is the first that I am aware of that evaluates a large PAD patient population over an extended period of time," said Dr. Russell H. Samson, director of the noninvasive lab, Sarasota (Fla.) Memorial Hospital, when asked to comment on this study.

"Two important points are made. Firstly, that all PAD patients, unless contraindicated, should be on intensive risk management with readily available, proven medications, i.e., aspirin, statin, b-blockers and an ACE (and I would suggest ARBs could be substituted for an ACE)," he added.

"Secondly, despite the increased awareness that such medications are necessary and despite the fact that it appears that they are being more frquently used (at least in the Netherlands), most patients are still being undertreated. It is critical that vascular surgeons get the message out to our medical colleagues: PAD patients are at high risk for cardiovascular mortality and intensive preventive measures are mandatory," Dr. Samson concluded.