Association between statin-use and mobility and long-term survival after major lower limb amputation

Arsalan Wafi; Vijay Kolli; Luis Ribeiro; Bilal Azhar; James Budge; Shreya Chawla; Paul Moxey; Ian M Loftus; Peter J E Holt

doi:10.1177/17085381231192724

Association between statin-use and mobility and long-term survival after major lower limb amputation

Vascular. 2023 Jul 31:17085381231192724. doi: 10.1177/17085381231192724. Online ahead of print.

Authors

Arsalan Wafi¹, Vijay Kolli², Luis Ribeiro¹, Bilal Azhar¹, James Budge¹, Shreya Chawla³, Paul Moxey¹, Ian M Loftus¹, Peter J E Holt¹

Affiliations

¹ St George's Vascular Institute, St George's University Hospital, London, UK.
² Douglas Bader Rehabilitation Unit, Queen Mary's Hospital, London, UK.
³ Imperial College London, London, UK.

PMID: 37524669
DOI: 10.1177/17085381231192724

Abstract

Aim: The aim of this study was to determine if there is an association between statin-use and prosthetic mobility and long-term survival in patients receiving rehabilitation after major amputation for lower limb arterial disease.

Methods: A retrospective analysis of prospectively maintained data (2008-2020) from a centre for rehabilitation was performed. Patients were grouped by statin-use status and sub-grouped by the combination of statin and antithrombotic drugs (antiplatelets or anticoagulants). Outcomes were prosthetic mobility (SIGAM score, timed-up-go and 2-min walking distance) and long-term survival. Regression, Kaplan-Meier and Cox-proportional hazard analyses were performed to test associations adjusted to confounders.

Results: Of 771 patients, 499 (64.7%) were on a statin before amputation or prescribed a statin peri-operatively. Rate of statin-use was significantly lower among female (53.3%) compared to male (68.2%) patients, P < 0.001. Statin-use was associated with significantly better prosthetic independence (53.1% vs 44.1%, P = 0.017), timed-up-go (mean difference of 4 s, P = 0.04) and long-term survival HR 0.59 (0.48-0.72, P < 0.001). Significance persisted after adjusting for confounding factors and in subgroup analyses. The combination of statin with antiplatelet was associated with the most superior survival, HR 0.51 (0.40-0.65, P < 0.001). Sensitivity analysis (exclusion of non-users of prosthesis) showed that statin-use remained a significant indicator of longer survival, maximally when combined with antiplatelet use HR 0.52 (0.39-0.68, P < 0.001).

Conclusions: Statin-use is associated with better mobility and long-term survival in rehabilitees after limb loss, particularly when used in combination with antiplatelets. Significantly lower rates of statin-use were observed in female patients. Further research is warranted on gender disparities in statin-use and causality in their association with improved mobility and survival.

Keywords: Statin; amputation; antiplatelet; mobility; rehabilitation; survival.