Abstract Body (Do not enter title and authors here): Background: Current guidelines recommend high-intensity statins in patients with peripheral artery disease (PAD) to reduce the risk of cardiovascular and limb events. The extent to which these recommendations have been adopted in a large integrated health system remains uncertain.

Methods: Using a novel natural language processing system that we previously developed and validated for identifying PAD, we created a registry of patients with a new diagnosis of PAD during 2015-2020 in the Veterans Health Administration (VHA). We used VHA pharmacy data to determine rates of active statin use at index date (date of PAD diagnosis), new initiation, persistence, and adherence (definitions in Table 1). High-intensity statin was based on statin type and dose. Analyses were also stratified by presence of pre-existing atherosclerotic cardiovascular disease (ASCVD), which was defined as a prior history of coronary or cerebrovascular disease.

Results: Among 103,748 patients, 64,159 (61.8%) were on statins at index date (baseline) and 30,968 (29.8%) were on high-intensity statins (Table 1). An additional 14,219 patients (13.7%) initiated statins within 1 year of PAD diagnosis, of whom 6,384 (6.2%) initiated high-intensity statins. Rates of active baseline use, or new initiation in 1 year were much lower in patients who did not have pre-existing ASCVD, compared to those with ASCVD (Table 1). Persistence with therapy among total active users was 78.0% for any statin and 78.6% for high-intensity statins. Mean adherence among persistent users was >80% for any statin and high intensity statin. Persistence and adherence did not differ in subgroups stratified by ASCVD.

Conclusion: Although more than 75% PAD patients were already on, or initiated a statin within 1 year of PAD diagnosis, only 36% were on high-intensity statins. Baseline use and new initiation of any statin and high-intensity statin was lower in PAD patients who did not have co-existing ASCVD. Overall, persistence among active users, and adherence among persistent users was high, and did not differ by statin intensity or pre-existing ASCVD. Given the strong evidence supporting high-intensity statins in PAD, interventions targeting intensifying statin therapy in PAD, especially in those without pre-existing ASCVD are warranted.