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CLINICAL RESEARCH: VASCULAR DISEASE

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

Harm H.H. Feringa, MD^_*, Virginie H. van Waning, MD^_*, Jeroen J. Bax, MD, PhD, Abdou Elhendy, MD, PhD^||, Eric Boersma, PhD, Olaf Schouten, MD, Wael Galal, MD^_*, Radosav V. Vidakovic, MD^||, Marco J. Tangelder, MD, PhD and Don Poldermans, MD, PhD^_*,_*

^_* Department of Anesthesiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
^|| Internal Medicine, Section of Cardiology, University of Nebraska, Omaha, Nebraska

Manuscript received July 11, 2005; revised manuscript received September 16, 2005, accepted September 19, 2005.

^_* Reprint requests and correspondence: Prof. Don Poldermans, Erasmus Medical Center, University of Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, the Netherlands (Email: d.poldermans{at}erasmusmc.nl).

OBJECTIVES: We sought to investigate the effect of cardiac medication on long-term mortality in patients with peripheral arterial disease (PAD).

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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) were significantly associated with a reduced risk of long-term mortality.

CONCLUSIONS: On the basis of this observational longitudinal study, statins, beta-blockers, aspirins, and ACE inhibitors are associated with a reduction in long-term mortality in patients with PAD.

Abbreviations and Acronyms   ABI = ankle-brachial index   ACE = angiotensin-converting enzyme   CI = confidence interval   HR = hazard ratio   PAD = peripheral arterial disease

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