LDL lowering in peripheral arterial disease:are there benefits beyond reducing cardiovascular morbidity and mortality?

Abstract

Peripheral arterial disease affecting the lower extremities is associated with increased mortality due to cardiovascular events and reduced functional capacity due to claudication. There is abundant evidence to support the role of lipid lowering with statins in preventing cardiovascular events in patients with peripheral arterial disease. Over the last 10 years, multiple studies have been designed to test the theory that LDL C lowering with statins could result in improved exercise performance in patients with peripheral arterial disease. However, this remains an active area of investigation to better understand how the pleiotropic effects of statins could lead to enhanced functional capacity for patients with claudication. Furthermore, new insights into the complex pathophysiology of claudication may help us to understand the potential role of lipid lowering therapy in alleviating exercise induced symptoms.

Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis

“…Given that the recent ACC/AHA guidelines recommend use statins in patients with an ABI b 0.9, it is even more unlikely that such trials will be started [39]. Further research may elucidate patient tolerance and adverse effects, as well as the pleiotropic effects of statins in the ever-increasing number of patients with asymptomatic, screendetected peripheral arterial disease [40][41][42][43]. In such future research, it would be important to understand the patient's view and to include more patient-reported outcomes.…”

Pathophysiology of peripheral arterial disease in diabetes mellitus

“…59 Interestingly, lowering LDL-C levels in PAD patients reduced cardiovascular mortality, ischemic complications of the extremities, altered atherosclerotic plaque progression, and improved exercise tolerance. 60 According to a recent Cochrane review of data from clinical trials of more than 10 049 individuals, lipid-lowering therapy is effective in reducing cardiovascular mortality and morbidity in people with PAD. 61 A study from the Heart Protection Study Collaborative Group indicated a 16 % relative reduction in the rate of first peripheral vascular event following cholesterol-lowering statin therapy in patients with PAD.…”

“…A recent study demonstrated that serum LOX‐1 was associated with ABI and represented a novel marker for PAD in patients with T2DM . Interestingly, lowering LDL‐C levels in PAD patients reduced cardiovascular mortality, ischemic complications of the extremities, altered atherosclerotic plaque progression, and improved exercise tolerance . According to a recent Cochrane review of data from clinical trials of more than 10 049 individuals, lipid‐lowering therapy is effective in reducing cardiovascular mortality and morbidity in people with PAD .…”

Impact of novel microbial secondary metabolites on the pharma industry

“…Inhibition of HMG-CoA reductase in the liver stimulates low-density lipoprotein (LDL) receptors, causing an increased LDL clearance from the bloodstream and decreased blood cholesterol levels. Their cholesterol-lowering effect reduces the risk of cardiovascular disease, prevents stroke, and drops peripheral vascular disease (Pollak and Kramer 2012 ). Besides, statins have an anti-thrombotic and anti-inflammatory effect.…”