High-Intensity Statins Underused in Veterans With PAD

A national registry analysis published online in Circulation: Population Health and Outcomes found that fewer than 4 in 10 Veterans with newly diagnosed peripheral artery disease (PAD) were using high-intensity statin therapy 1 year after diagnosis, despite guideline recommendations for high-intensity statins in this population.

The PEARLS study included 91,970 patients with incident PAD who were alive 1 year after diagnosis. Median age was 70 years, 97.2% were men, and 18.6% were Black. Researchers used pharmacy claims to determine active statin use during the first year and laboratory results to assess lipid levels. Hierarchical multivariable logistic regression was used to identify patient factors associated with statin use and evaluate variation among sites.

At 1 year, 64,231 patients (69.9%) were receiving any statin, and 34,017 (37.0%) were receiving a high-intensity statin. Among 27,739 patients not taking a statin, 14,834 (53.4%) had not been prescribed one at any point during the preceding 3 years.

Median low-density lipoprotein cholesterol was 81.6mg/dL overall. Values were 72.2mg/dL among patients receiving high-intensity statins, 78.0mg/dL among those receiving low- or moderate-intensity treatment, and 100mg/dL among nonusers. Older age, coronary artery disease, cerebrovascular disease, hypertension, diabetes, current or former smoking, obesity, and revascularization within 6 months of diagnosis were associated with greater statin use and, among statin users, high-intensity therapy. High-intensity statin use ranged from 20% to 54% across sites, with a median odds ratio of 1.39 (95% CI, 1.32-1.46).

The investigators concluded that overall statin use approached 70%, but high-intensity statin and nonstatin lipid-lowering therapy remained underused. They said the observed site-level variation, particularly for high-intensity therapy, indicated opportunities to improve guideline-concordant care in Veterans with PAD.

Source: Nathani R, Nguyen C, Li Q, et al. Statins use in veterans with peripheral artery disease: insights from the PEARLS study. Circ Popul Health Outcomes. Published online September 2, 2026. doi:10.1161/CIRCOUTCOMES.125.013213