Statins and Peripheral Arterial Disease: A Narrative Review

Abstract

Peripheral arterial disease (PAD) is a highly prevalent atherosclerotic condition. In patients with PAD, the presence of intermittent claudication leads to a deterioration in quality of life. In addition, even in asymptomatic cases, patients with PAD are at high risk of cardiac or cerebrovascular events. Treatment of PAD is based on lifestyle modifications; regular exercise; smoking cessation; and control of cardiovascular risk factors, including hypercholesterolemia. A growing number of studies have shown that statins reduce cardiovascular risk and improve symptoms associated with PAD. Current guidelines recommend the use of statins in all patients with PAD in order to decrease cardiovascular events and mortality. However, the prescribing of statins in patients with PAD is lower than in those with coronary heart disease. This review provides relevant information from the literature that supports the use of statins in patients with PAD and shows their potential benefit in decreasing lower limb complications as well as cardiovascular morbidity and mortality.

The Potential Role of Antioxidants in the Treatment of Peripheral Arterial Disease: A Systematic Review

“…Finally, due to the multifactorial nature of PAD, using antioxidants as a definitive treatment alone may not be effective [ 6 ]. Therefore, using additional therapies according to the patient’s underlying disease (anticoagulants, antiplatelet agents, antihypertensives, antidiabetic agents, and statins) along with the appropriate amount of antioxidants seems to be more effective [ 6 , 34 ]. Due to the positive feedback between the initiator (cause) of pathogenesis and its consequences, there is an interaction between the oxidative stress level and thrombosis, leading to the elevation of both [ 35 ].…”

Diabetic dyslipidemia impairs coronary collateral formation: An update

“…Statins effectively decrease serum LDL-C and sdLDL-C while increasing HDL-C levels and reduce the susceptibility of apo B of LDL to undergo oxidation and glycation. They also display significant anti-inflammatory properties and improve endothelial function (so-called pleiotropic effects) ( 71 ). Robust evidence supports the fact that use of statins enhances angiogenesis as well as arteriogenesis independent of a cholesterol-lowering mechanism ( 72 , 73 ).…”

Role of Lipid-Lowering Therapy in Peripheral Artery Disease

“…Mondillo et al, reported a 90-m increase in pain-free walking distance in PAD patients after 6 months of simvastatin therapy ( p < 0.005) [ 38 ]. In addition to increasing pain-free walking distance [ 39 ], statins have been shown to increase total walking distance [ 40 , 41 , 42 , 43 , 44 ], reduce severity of IC [ 45 ] and improve overall quality of life [ 43 , 46 , 47 ], especially when combined with an exercise regimen [ 48 ].…”