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CLINICAL RESEARCH: ATHEROSCLEROSIS

Statin Use and Functional Decline in Patients With and Without Peripheral Arterial Disease

Jay Giri, MD, MPH^_*, Mary M. McDermott, MD^,_*, Philip Greenland, MD, Jack M. Guralnik, MD, PhD, Michael H. Criqui, MD, MPH, Kiang Liu, PhD, Luigi Ferrucci, MD, PhD^||, David Green, MD, PhD, Joseph R. Schneider, MD, PhD^¶ and Lu Tian, ScD

^_* Massachusetts General Hospital, Boston, Massachusetts
Northwestern University Feinberg School of Medicine, Chicago, Illinois
Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland
University of California at San Diego, San Diego, California
^|| Clinical Research Branch, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
^¶ Evanston/Northwestern Hospital, Evanston, Illinois

Manuscript received March 31, 2005; revised manuscript received October 5, 2005, accepted October 7, 2005.

^_* Reprint requests and correspondence: Dr. Mary M. McDermott, 676 North St. Clair, Suite 200, Chicago, Illinois 60611. (Email: mdm608{at}northwestern.edu).

OBJECTIVES: We determined whether statin use (vs. non-use) is associated with less annual decline in lower-extremity functioning in patients with and without lower-extremity peripheral arterial disease (PAD) over three-year follow-up.

BACKGROUND: It is unclear whether statin use is associated with less functional decline in patients with PAD.

METHODS: Participants included 332 men and women with an ankle brachial index (ABI) <0.90 and 212 with ABI 0.90 to 1.50. Functional outcomes included 6-min walk distance and usual and rapid-pace 4-m walking velocity. A summary performance score combined performance in walking speed, standing balance, and time for five repeated chair rises into an ordinal score ranging from 0 to 12 (12 = best).

RESULTS: Adjusting for age, race, gender, comorbidities, education, health insurance, total cholesterol/high-density lipoprotein level, body mass index, pack-years of smoking, leg symptoms, immediately previous year functioning, statin use/non-use, ABI, and change in ABI, the PAD participants using statins had less annual decline in usual-pace walking velocity (0.002 vs. –0.024 m/s/year, p = 0.013), rapid-pace walking velocity (–0.006 vs. –0.042 m/s/year, p = 0.006), 6-min walk performance (–34.5 vs. –57.9 feet/year, p = 0.088), and the summary performance score (–0.152 vs. –0.376, p = 0.067) compared with non-users. These associations were attenuated slightly by additional adjustment for high-sensitivity C-reactive protein levels. Among non-PAD participants, there were no significant associations between statin use and functional decline.

CONCLUSIONS: The PAD patients on statins have less annual decline in lower-extremity performance than PAD patients who are not taking statins.

Abbreviations and Acronyms   ABI = ankle-brachial index   BMI = body mass index   HDL = high-density lipoprotein   hsCRP = high-sensitivity C-reactive protein   PAD = peripheral arterial disease

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