The Role of Statin Drugs in the Management of the Peripheral Vascular Patient

Abstract

The impact of statin therapy on established vascular conditions and recurrent disease is most relevant for long-term care. Patients receiving statin therapy have been shown to experience less recurrent stenosis following carotid endarterectomy and stent angioplasty, reduced cardiac events following cardiac and noncardiac vascular surgery, and reduction in aneurysm development. In patients with peripheral arterial disease, claudication distance is increased, as well as patency rates following infrainguinal arterial bypass grafting. Of note, statins drugs may also prove beneficial in the prevention of certain cancers, Alzheimer's disease, and osteoporosis (all diseases frequently seen concurrently in the patient with peripheral arterial disease). As such, it is becoming all the more necessary that vascular surgeons remain informed about clinical research initiatives related to statin use and lipid management in general. The following is a review of lipid metabolism as it applies to statins as well as a review of the beneficial effects of statins.

Patterns of treatment for peripheral arterial disease in the United States: 1996-2005

“…Advances in medical therapy such as the expanded role of statin agents and the development of more aggressive antiplatelet drugs, as well as decreased smoking prevalence may also have contributed to the decreased rates of amputation described in this report. [30][31][32][33] Also, our report does not account for the widespread improvements in PAD screening programs. The impact of population-based efforts to increase PAD awareness should not be ignored.…”

An analysis of the outcomes of a decade of experience with lower extremity revascularization including limb salvage, lengths of stay, and safety

“…15,16 For example, vascular patients receiving perioperative statin therapy had fewer complications after surgery than patients receiving a placebo. 17 Statin therapy also increased the improvement of claudication symptoms and was associated with a shorter hospital LOS for patients undergoing infrainguinal vascular surgery. 17,18 A limitation of this and similar studies is the reliance on the selective data available in large health care administrative data sets.…”

“…17 Statin therapy also increased the improvement of claudication symptoms and was associated with a shorter hospital LOS for patients undergoing infrainguinal vascular surgery. 17,18 A limitation of this and similar studies is the reliance on the selective data available in large health care administrative data sets. The primary purpose of these data sets is to credit reimbursement for hospital care delivered, and therefore, they lack the physiologic variables and anatomic characteristics needed to produce a thorough analysis of treatment groups.…”

Statin use is associated with improved overall survival without affecting patency and limb salvage rates following open or endovascular revascularization

“…The statin drugs are one of the mainstays for medical management of patients with PAD, 10,19,20 and their beneficial effects are mediated by both lipid-reducing and plaque stabilization properties. 2 Their use has been associated with early and late survival benefits in patients with various manifestations of arterial disease, 16,21,22 but their effects on improving patency and limb salvage rates have been reported with conflicting results, 12-15 possibly due to different patient populations with divergent endpoints.…”