Pharmacotherapy and outcome in intermittent claudication

Abstract Background Intermittent claudication (IC) carries an increased risk of vascular death compared with that in age-matched controls. The role of antiplatelets and statins in the reduction of this risk in new claudicants was evaluated in an observational study of a prospectively gathered database, the General Practice Research Database (GPRD), with 430 practices contributing 8 million patients in the UK. Methods All patients aged 40–79 years with newly diagnosed IC and no history of previous peripheral vascular disease were identified using recognized GPRD OXMIS codes. Prescription of antiplatelet therapy (APT) up to 12 months before or after diagnosis, and the use of statin therapy (ST) at the time of diagnosis, of IC was noted. Odds ratios (ORs) adjusted for APT, ST, sex, age, smoking, diabetes, and coexisting cardiac and cerebrovascular disease were calculated. Patients with critical limb ischaemia were excluded. Outcome measures were all-cause death, fatal stroke and fatal myocardial infarction (MI) up to 5 years after diagnosis of IC. Results Between 1988 and 1993, 20 474 patients with newly diagnosed IC were identified. The Table summarizes the results. Conclusion Prescription rates of statins and antiplatelets in new claudicants in the UK are low and could be improved. These results suggest that ST is associated with a significant reduction in all-cause mortality rate in new claudicants. Patients receiving APT demonstrated a significant reduction in death from MI.