Cardioprotective Medication Is Associated With Improved Survival in Patients With Peripheral Arterial Disease

• Published in: Journal of the American College of Cardiology 2006-03, Vol.47 (6), p.1182-1187
• Main Authors: Feringa, Harm H.H., van Waning, Virginie H., Bax, Jeroen J., Elhendy, Abdou, Boersma, Eric, Schouten, Olaf, Galal, Wael, Vidakovic, Radosav V., Tangelder, Marco J., Poldermans, Don
• Format: Article
• Language: English
• Subjects: Angina pectoris; Ankle; Aspirin; Atherosclerosis - drug therapy; Atherosclerosis - mortality; Bias; Biological and medical sciences; Blood and lymphatic vessels; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Confidence intervals; Coronary vessels; Diabetes; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drug therapy; Enzymes; Family medical history; Female; Heart attacks; Heart failure; Humans; Hypertension; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Multivariate analysis; Nitrates; Peripheral Vascular Diseases - drug therapy; Peripheral Vascular Diseases - mortality; Prospective Studies; Protective Agents - therapeutic use; Survival Rate; Time Factors; Walking
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2005.09.074

Cardioprotective Medication Is Associated With Improved Survival in Patients With Peripheral Arterial Disease Harm H. H. Feringa, Virginie H. van Waning, Jeroen J. Bax, Abdou Elhendy, Eric Boersma, Olaf Schouten, Wael Galal, Radosav V. Vidakovic, Marco J. Tangelder, Don Poldermans The effect of cardiac medication on long-term mortality in patients with peripheral arterial disease remains ill defined. In a prospective observational cohort study, 2,420 patients with peripheral arterial disease were screened for clinical risk factors and chronic cardiac medication use. Follow-up end point was all-cause mortality. During a median follow-up of eight years, 1,067 patients (44%) died. After adjustment for clinical risk factors and propensity scores, statins, beta-blockers, aspirins, and angiotensin-converting enzyme inhibitors were significantly associated with a reduced risk of long-term mortality. We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease (PAD). Peripheral arterial disease is associated with increased cardiovascular morbidity and mortality. Treatment guidelines recommend aggressive management of risk factors and lifestyle modifications. However, the potential benefit of cardiac medication in patients with PAD remains ill defined. In this prospective observational cohort study, 2,420 consecutive patients (age, 64 ± 11 years, 72% men) with PAD (ankle-brachial index ≤0.90) were screened for clinical risk factors and cardiac medication. Follow-up end point was death from any cause. Propensity scores for statins, beta-blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers, diuretics, nitrates, coumarins, and digoxin were calculated. Cox regression models were used to analyze the relation between cardiac medication and long-term mortality. Medical history included diabetes mellitus in 436 patients (18%), hypercholesterolemia in 581 (24%), smoking in 837 (35%), hypertension in 1,162 (48%), coronary artery disease in 1,065 (44%), and a history of heart failure in 214 (9%). Mean ankle-brachial index was 0.58 (±0.18). During a median follow-up of eight years, 1,067 patients (44%) died. After adjustment for risk factors and propensity scores, statins (hazard ratio [HR] 0.46, 95% confidence interval [CI] 0.36 to 0.58), beta-blockers (HR 0.68, 95% CI 0.58 to 0.80), aspirins (HR 0.72, 95% CI 0.61 to 0.84), and ACE inhibitors (HR 0.80, 95% CI 0.69 to 0.94)