Factors Associated with Reinitiation of Statin Treatment in Older Patients with Peripheral Arterial Disease
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ORIGINAL RESEARCH ARTICLE
Factors Associated with Reinitiation of Statin Treatment in Older Patients with Peripheral Arterial Disease Martin Wawruch1 · Gejza Wimmer Jr2 · Jan Murin3 · Martina Paduchova4 · Tomas Tesar5 · Lubica Hlinkova6,7 · Peter Slavkovsky8 · Emma Aarnio9,10
© Springer Nature Switzerland AG 2020
Abstract Background Long-term persistence represents a basic precondition of successful statin treatment in patients with peripheral arterial disease (PAD). Objectives The aims of our study were evaluation of reinitiation in older PAD patients who were non-persistent with statin treatment, and identification of patient-related characteristics associated with the patient’s probability of reinitiation. Methods Our study cohort included 2977 older patients (≥ 65 years) who were non-persistent with statin treatment in whom PAD was newly diagnosed in 2012. Reinitiation was defined as the first statin prescription recorded after discontinuation. To analyze factors associated with the patient´s probability of reinitiation, Cox regression with time-dependent covariates was applied. Results After post-discontinuation follow-up of a mean of 27 months, reinitiation of statin treatment was recorded for 1244 (41.8%) patients. Increasing age, Parkinson’s disease, being a new statin user (patient in whom statin treatment was initiated in association with PAD diagnosis), general practitioner as the index prescriber who prescribed a statin for the first time after diagnosis of PAD, coadministration of loop diuretics, and longer persistence before discontinuation decreased the patient’s likelihood of reinitiation, whereas myocardial infarction during non-persistence, high-intensity statin treatment, and increasing number of medications increased the patient’s probability of reinitiation. Conclusions In patients with characteristics associated with a lower probability of reinitiation, more concentrated outreach and further evaluation of these groups to identify interventions that might be helpful to encourage reinitiation are needed.
1 Introduction Peripheral arterial disease (PAD), which, in our study, refers to ischemic disease affecting the lower extremities, has high prevalence. According to Ostchega et al., the prevalence of PAD in older adults in the US (≥ 60 years) was 12.2%, which increases with increasing age [1]. Kalbaugh et al. reported a weighted mean age-standardized prevalence and incidence rate of outpatient PAD of 11.8% and 22.4 per 1000 person-years, respectively [2]. Although the agestandardized mortality for cardiovascular (CV) and circulatory diseases decreased by 22% between 1990 and 2013, an increase has been recorded for PAD, as evidenced by the * Martin Wawruch [email protected]; [email protected] * Tomas Tesar [email protected] Extended author information available on the last page of the article
age-standardized death rate (per 100,000) of 0.5 in 1990 and 0.7 in 2013 [3]. There are many causes of PAD, such as trauma, degenerative conditions, or thromboembolism; howe
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