Effects of lipid-lowering therapy on major adverse limb events in patients with peripheral arterial disease: A meta-analysis of randomized clinical trials

Abstract

Objective Patients with peripheral artery disease (PAD) are at increased risk of major adverse limb events (MALE). Furthermore, MALE have several clinical implications and a poor prognosis, so prevention is a fundamental issue. The main objective of the present meta-analysis of randomized clinical trials is to evaluate the effect of different lipid-lowering therapies on MALE incidence in patients with PAD. Methods A meta-analysis of randomized studies that evaluated the use of lipid-lowering therapy in patients with PAD and reported MALE was performed, after searching the PubMed/MEDLINE, Embase, ScieLO, Google Scholar, and Cochrane Controlled Trials databases. A fixed- or random-effects model was used. Results Five randomized clinical trials including 11,603 patients were identified and considered eligible for the analyses (5903 subjects were allocated to receive lipid-lowering therapy, while 5700 subjects were allocated to the respective placebo/control arms). The present meta-analysis revealed that lipid-lowering therapy was associated with a lower incidence of MALE (OR: 0.76, 95% confidence interval: 0.66–0.87; I2: 28%) compared to placebo/control groups. The sensitivity analysis shows that the results are robust. Conclusion This study demonstrated that the use of lipid-lowering therapy compared with the placebo/control arms was associated with a marked reduction in the risk of MALE. Physicians involved in the monitoring and treatment of patients with PAD must work hard to ensure adequate lipid-lowering medication in these patients.

Konservative Therapie und Sekundärprävention der pAVK

“…Oft wird in kritischen Diskussionen der relevante Aspekt der Plaque-Stabilisierung vergessen, zudem zeigen Metaanalysen einen klaren Nutzen in Bezug auf kardiovaskuläre (MACE) und extremitätenbezogene (MALE) Endpunkte. So konnten durch lipidsenkende Therapien Majoramputationen, akute Extremitätenischämien und Revaskularisationen um 24 % im Vergleich zu Placebo reduziert werden [5]. Die Europäische pAVK-Leitlinie empfiehlt daher eine mindestens 50 %ige Absenkung des LDLs bei Ausgangswerten zwischen 70-135 mg/dl (1,8-3,5 mmol/l) bzw.…”

Update – Lipidsenkende Therapie bei pAVK

“…B. durch Myokardinfarkt oder Schlaganfall). Lipidsenkung bedeutet mehr als nur "Laborkosmetik": So zeigt sich ein klarer Nutzen bei den kardiovaskulären Endpunkten MACE (Herzinfarkt, Schlaganfall, kardiovaskulärer Tod) und bei den Extremitäten-Endpunkten MALE (Major-Amputation, akute Ischämie, akute Intervention bei kritischer Ischämie), wie Metaanalysen belegen [1,2]. Dass der Erhalt einer Extremität Relevanz für Lebensqualität, Mobilitätserhalt, Verhinderung einer Pflegebe-dürftigkeit etc.…”