(PC032) Impact of lipid control on Peripheral Artery Disease revascularization outcomes

Objectives: Few studies have evaluated the association between guideline-directed lipid-lowering agent use and the degree of lipid control on outcomes after lower extremity revascularization for Peripheral Artery Disease(PAD). Also, the interaction between lipid control and gender in patients undergoing revascularization for PAD is not well defined. In this context, we evaluate the impact of lipid-lowering therapy and degree of lipid control on outcomes in patients undergoing lower extremity revascularization for PAD. Our hypothesis is that the use of lipid-lowering agents as well as the degree of lipid control have an impact on short- and long-term outcomes. Further, we seek to investigate the association of gender and outcomes when lipid-lowering therapy is used and lipid levels are well-controlled.

Methods: We queried the electronic medical record database at a quaternary care academic institution to identify all patients aged 18 years or older undergoing open or endovascular lower extremity revascularization for PAD between January 1, 2010 and December 31, 2022. Patients were categorized based on gender for evaluation. Pre- and post-operative fasting lipid levels were evaluated including total cholesterol, HDL, LDL, and triglycerides. Major Adverse Limb Events (MALE) was defined as re-intervention, redo revascularization and major amputation within 30 days of intervention. Kaplan Meier analysis was used to compare 5-year overall survival (OS) comparing outcomes based on gender.

Results: 1,096 patients met inclusion criteria, 666 (60.8%) male and 430 (39.2%) female. A total of 831 patients (75.8%) received pre-operative statin therapy. 501 (75.2%) of males and 330 (76.7%) of females were on pre-operative statin. 177 patients (21.3%) on statin therapy demonstrated well-controlled pre-operative LDL levels ( < 70 mg/dL). On unadjusted analysis, female patients on pre-operative statin therapy had higher mean pre-operative total cholesterol levels (163.1±47.3 vs 145.5±41.2, p< 0.01), higher pre-operative LDL levels (92.8±41.8 vs 82.2±35.1, p< 0.01), and higher pre-operative HDL levels (48.1±14.7 vs 40.2±12.7, p< 0.01) than their male counterparts. Of patients on pre-operative statin therapy, females demonstrated similar rates of MALE (8.79% vs 6.99%, p=0.340), 90-day mortality (43.6% vs 56.4%, p=0.570), and 5-year OS (91.8% vs 86.7%, p=0.991) as males.

Conclusions: In patients with PAD undergoing lower extremity revascularization, pre-operative statin therapy use does not impact outcomes. Female patients on pre-operative statin therapy are more likely to have higher pre-operative lipid levels, but demonstrate similar rates of MALE, 90-day mortality, and 5-year OS compared to male patients. There is a trend towards improved 5-year OS in patients on pre-operative statin therapy regardless of gender.