Medication Use for Primary Prevention of Atherosclerotic Cardiovascular Disease among Adults with Lower-Limb Loss

Research Objectives: To investigate cardioprotective medication use for primary prevention of atherosclerotic cardiovascular disease (ASCVD) among community-dwelling adults with lower-limb loss (LLL) with significant risk factors for ASCVD.

Design: Secondary analysis of a cross-sectional dataset.

Setting: Outpatient interdisciplinary limb-loss clinic held between 2013 and 2022.

Participants: Consecutive sample of N=132 at-risk adults with LLL without ASCVD as determined from self-reported history of a major adverse cardiovascular event.

Interventions: Not applicable.

Main Outcome Measures: Outcomes included prescription of blood pressure-lowering, cholesterol-lowering, and antithrombotic agents, and blood pressure.

Results: The sample included 132 participants with a mean age of 54.7±12.6 years; 72.7% were male, 68.2% were Caucasian, and 59.1% had > high school education. In terms of amputation-specifics, 49.2% had dysvascular etiology and 61.4% had a below-the-knee amputation. The most prevalent ASCVD risk factors were hypertension (57.6%), inactivity (50.8%), obesity (49.6%), tobacco use (43.9%), and hyperlipidemia (40.9%), with 83.3% of the sample reporting ≥2 major risk factors. Approximately 25% of the sample (n=34) reported no pharmacologic intervention, of whom 25 (73.5%) had ≥2 major ASCVD risk factors. The median number of cardioprotective medications was 1 (25th, 75th percentile: 0, 3), with a large proportion of participants reporting blood pressure-lowering (n=75; 56.8%), cholesterol-lowering (n=54; 40.9%) and antithrombotic agents (n=50; 37.9%). Of the 54 participants with self-reported hyperlipidemia, 74% were on cholesterol-lowering medications. Of the 76 participants who reported hypertension, 82.8% had been prescribed a blood pressure-lowering medication. But, among the 75 participants on blood pressure-lowering medications, only 49% presented with adequate blood pressure control (resting pressure < 140/90 mmHg).

Conclusions: Despite high prevalence of ASCVD risk factors, the proportion of adults with LLL not receiving cardioprotective medications was high. Further, risk factors, such as hypertension, may not be adequately managed. In summary, findings suggest adults with LLL may be undertreated for ASCVD risk.

Author(s) Disclosures: Stauffer’s PhD is funded by the Independence Prosthetics-Orthotics Graduate Education Fund. The authors have no other relevant financial conflicts of interest to disclose.