Comparison of Lipid Management in Patients With Coronary Versus Peripheral Arterial Disease Suresh Sharma, MD a , Rashmi Thapa, MD a , Vinodh Jeevanantham, MD, MPH a , Taylor Myers, BS a , Casper Hu, BS a , Michael Brimacombe, PhD b , James L. Vacek, MD, MSc a , Buddhadeb Dawn, MD a , and Kamal Gupta, MD a, * Peripheral arterial disease (PAD), similar to coronary artery disease (CAD), is a significant predictor of cardiovascular morbidity and mortality. Guidelines recommend a low-density lipoprotein (LDL) goal of <100 mg/dl for both groups. We assessed whether lipid control and statin use were as aggressively applied to PAD as to patients with CAD. This retro- spective study of patients with the diagnosis of CAD, PAD, or both CAD and PAD compared lipid levels and statin use. For comparison of statins, we used a statin potency unit (1 potency unit [ 10 mg of simvastatin). Among 11,134 subjects (CAD 9,563, PAD 596, and both CAD and PAD 975), mean LDL in the PAD group was higher than the CAD (92 vs 83 mg/dl, respectively, p <0.001) and the combined CAD and PAD groups (92 vs 80 mg/dl, respectively, p <0.001). Fewer patients with PAD achieved a target LDL of <100 mg/dl compared with CAD (62% vs 78%, respectively, p <0.001) and the combined group (62% vs 79%, respectively, p <0.001). Similar differences were noted for a target LDL of <70 mg/dl. Compared with the CAD group, a lesser number of patients with PAD received statin therapy (76% vs 100%, respectively, p <0.001) with lower mean potency unit (5.3 vs 8.1, respectively, p <0.001). In conclusion, our study demonstrated lower use and less aggressive application of statins in patients with PAD compared with patients with CAD, ensuing lower mean LDL in the CAD and combined PAD and CAD groups. Our study suggests that physicians are more aggressive with lipid control in patients with CAD compared with patients with PAD alone. Ó 2014 Elsevier Inc. All rights reserved. (Am J Cardiol 2014;113:1320e1325) There is paucity of published reports that compare the treatment goals achieved among patients with peripheral arterial disease (PAD) compared with coronary artery disease (CAD). Furthermore, little is known if the target lipid control and use of lipid-lowering therapy are similar in patients with diagnosis of PAD alone versus patient with associated diag- nosis of CAD with PAD. We hypothesize that compared with patients with CAD, a greater proportion of PAD-only patients continue to receive less aggressive lipid-lowering treatment in current clinical practice. Therefore our study aims to (1) compare lipid control between PAD versus CAD groups and PAD versus combined CAD and PAD groups and (2) compare statin use between PAD versus CAD groups and PAD versus combined CAD and PAD groups. Methods This is a retrospective observational study conducted in a large academic healthcare system. The Institutional Research Board of the University of Kansas Medical Center, where this study was conducted, approved the study. Electronic medical records from January 2009 to March 2012 were reviewed, and ambulatory patients who were 18 years of age or older and had International Classification of Disease codes for CAD, PAD, or both listed under the problem list were identified as the study population. Sub- jects were included in the study only if their lipid profile and medication lists were available in the electronic medical record system. Based on the diagnostic codes, patients were categorized into 3groups—CAD only, PAD only, or com- bined CAD and PAD. Demographic variables, last lipid profile available, co-morbidities, and statin therapy were compared among the 3 groups. The percentage of patients with low-density lipoprotein (LDL) levels <100 and <70 mg/dl was compared among the PAD, CAD, and combined CAD and PAD groups. Mean levels of total cholesterol, high-density lipoprotein cholesterol, LDL cholesterol, and triglycerides were also compared among the 3 groups. We identified the statins used and the mean doses utilized for each agent. To compare the various doses of statins used, we converted all statin doses to an equivalent potency unit, based on the comparative efficacy of the currently used statins on lipids levels, 1e3 where 1 potency unit ¼ 10 mg of simvastatin. For ezetimibe/statin combi- nations, the potency unit conversion was based on the strength of the statin considering the uniform dose of 10 mg of ezetimibe. For niacin/statin combinations, the potency unit conversion was also based on the strength of statin. Statistical analysis was performed using the Statistical Program for Social Sciences (version 19.0; SPSS, Inc., a Department of Internal Medicine, Division of Cardiovascular Diseases and b Department of Biostatistics, University of Kansas Medical Center and Hospital, Kansas City, Kansas. Manuscript received November 13, 2013; revised manuscript received and accepted January 8, 2014. See page 1324 for disclosure information. *Corresponding author: Tel: (913) 588-9601; fax: (913) 588-6010. E-mail address: kgupta@kumc.edu (K. Gupta). 0002-9149/14/$ - see front matter Ó 2014 Elsevier Inc. All rights reserved. www.ajconline.org http://dx.doi.org/10.1016/j.amjcard.2014.01.405