Evidence map›Paper›PMID 29330214›Full record

ArticleCirculation2018

Association of Statin Dose With Amputation and Survival in Patients With Peripheral Artery Disease.

Shipra Arya, Anjali Khakharia, Zachary O Binney, Randall R DeMartino, Luke P Brewster, Philip P Goodney, Peter W F Wilson

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04400409 (Implementation of Vascular Care Team to Improve Medical Management of Peripheral Arterial Disease), which is not on this map. Cited by 86 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 6 pooled it
26.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04400409 nacompletednot on this mapstarted 2020, after this paper: background citation

Implementation of Vascular Care Team to Improve Medical Management of Peripheral Arterial Disease (PAD) Patients

TypeinterventionalSponsorColorado Prevention CenterRan2020 to 2023Enrolled166ConditionsPeripheral Artery DiseaseArmsIntervention A - Vascular Care + site 6MWT administration, Intervention B - Standard Care + site 6MWT administration, Intervention A - Vascular Care + CPC EQuIP 6MWT administration, Intervention B - Standard Care + CPC EQuIP 6MWT administration
3 · Its place in the literature

Who cites it

86 citing papers in PubMed, 6 syntheses or guidelines pooled it, 246 citations in OpenAlex.

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  9. 2025 Egyptian guidelines for the management of dyslipidemia.The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology · 2026
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26 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors at 5 institutions in 1 country.

Shipra AryaDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery (S.A., A.K., L.P.B.) sarya1@stanford.edu.
Anjali KhakhariaDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery (S.A., A.K., L.P.B.).
Zachary O BinneyEmory School of Medicine, and Department of Epidemiology, Rollins School of Public Health (S.A., Z.O.B.), Emory University, Atlanta, GA.
Randall R DeMartinoDivision of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN (R.R.D.).
Luke P BrewsterDivision of Vascular Surgery and Endovascular Therapy, Department of Surgery (S.A., A.K., L.P.B.).
Philip P GoodneySection of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH (P.P.G.).
Peter W F WilsonDivision of Cardiology (P.W.F.W.).
Emory University · USAtlanta VA Medical Center · USBrewster Place · USDartmouth–Hitchcock Medical Center · USMayo Clinic in Arizona · US

Funding

Molecular Mechanism of Disturbed Flow in Arterial StiffeningK08HL119592 · NHLBI · EMORY UNIVERSITY · PI BREWSTER, LUKE PACKARD · 2014 to 2018
$690k
Failure to rescue in frail surgical patientsR03AG050930 · NIA · STANFORD UNIVERSITY · PI ARYA, SHIPRA · 2016 to 2017
$234k
Prediction of CVD Risk in VeteransI01CX001025 · VA · VETERANS HEALTH ADMINISTRATION · PI CHO, KELLY, WILSON, PETER WYMAN · 2014 to 2025
–
CSRD VA I01 CX001025NHLBI NIH HHS K08 HL119592NIA NIH HHS R03 AG050930
6 · The paper itself

Abstract

backgroundStatin dose guidelines for patients with peripheral artery disease (PAD) are largely based on coronary artery disease and stroke data. The aim of this study is to determine the effect of statin intensity on PAD outcomes of amputation and mortality.

methodsUsing an observational cohort study design and a validated algorithm, we identified patients with incident PAD (2003-2014) in the national Veterans Affairs data. Highest statin intensity exposure (high-intensity versus low-to-moderate-intensity versus antiplatelet therapy but no statin use) was determined within 1 year of diagnosis of PAD. Outcomes of interest were lower extremity amputations and death. The association of statin intensity with incident amputation and mortality was assessed with Kaplan-Meier plots, Cox proportional hazards modeling, propensity score-matched analysis, and sensitivity and subgroup analyses, as well, to reduce confounding.

resultsIn 155 647 patients with incident PAD, more than a quarter (28%) were not on statins. Use of high-intensity statins was lowest in patients with PAD only (6.4%) in comparison with comorbid coronary/carotid disease (18.4%). Incident amputation and mortality risk declined significantly with any statin use in comparison with the antiplatelet therapy-only group. In adjusted Cox models, the high-intensity statin users were associated with lower amputation risk and mortality in comparison with antiplatelet therapy-only users (hazard ratio, 0.67; 95% confidence interval, 0.61-0.74 and hazard ratio, 0.74; 95% confidence interval, 0.70-0.77, respectively). Low-to-moderate-intensity statins also had significant reductions in the risk of amputation and mortality (hazard ratio amputation, 0.81; 95% confidence interval, 0.75- 0.86; hazard ratio death, 0.83; 95% confidence interval, 0.81-0.86) in comparison with no statins (antiplatelet therapy only), but effect size was significantly weaker than the high-intensity statins (

conclusionsStatins, especially high-intensity formulations, are underused in patients with PAD. This is the first population-based study to show that high-intensity statin use at the time of PAD diagnosis is associated with a significant reduction in limb loss and mortality in comparison with low-to-moderate-intensity statin users, and patients treated only with antiplatelet medications but not with statins, as well.

Indexed as

AgedAmputation, SurgicalComorbidityDose-Response Relationship, DrugFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsKaplan-Meier EstimateMaleMiddle AgedPeripheral Arterial DiseasePlatelet Aggregation InhibitorsPropensity ScoreProportional Hazards ModelsRisk FactorsTreatment OutcomeHydroxymethylglutaryl-CoA Reductase InhibitorsPlatelet Aggregation Inhibitorsamputationhydroxymethylglutaryl-CoA reductase inhibitorsmortalityperipheral arterial diseasepropensity scorevascular medicineveterans health

Identifiers

PMID29330214
PMCPMC5882502
OpenAlexW2783484560

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.