末梢動脈疾患に対してスタチンを開始するのに遅すぎることはない(Abstract 80087)
末梢動脈疾患（PAD）患者において、スタチン系薬剤は診断後に遅れて開始された場合でも死亡率を低下させた、と ESC Congress 2019 で発表された。EUROASPIRE 試験において、スタチン内服を中止した患者の死亡率（33%）は、一度も内服したことのない患者と同等（34%）であった。試験期間50か月にわたりスタチン内服を遵守することは、20% の死亡率と関連があった。試験期間中の高用量スタチンの内服は、最も低い死亡率（10%）と関連し、同じ期間中の用量減量は最も高い死亡率と関連した。
Statins are linked with reduced mortality in patients with peripheral arterial disease, even when started late after diagnosis, reports a study presented at ESC Congress 2019 together with the World Congress of Cardiology. 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.
Around 200 million people worldwide have peripheral arterial disease (PAD). Statins are recommended for all patients with PAD, together with smoking cessation, exercise, healthy diet, and weight loss.
But adherence to statins is low: over the past five years, just 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 of below 1.8 mmol/L (70 mg/ dl).
This study examined whether adherence to statin therapy influenced survival in patients with symptomatic PAD. The study enrolled 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. The dose of drug also increased between the two time periods, which was paralleled by a significant drop in LDL cholesterol from 97 to 82 mg/dL.
Patients who stopped taking a statin had a similar mortality rate (33%) to those who never took the drug (34%). Adhering 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%).
Study author Dr. Jörn 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."
He concluded: "All PAD patients should take statins, preferably very potent statins, like rosuvastatin 40 mg or atorvastatin 80 mg, 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."
No funding was received for this study.
