Effectiveness of Propionyl-L-Carnitine Supplementation on Exercise Performance in Intermittent Claudication: A Systematic Review.

Belen Tama,Daniel Zarrate,Anas Anas Sohail,Stephanie P Fabara

doi:10.7759/cureus.17592

Abstract

Lower extremity peripheral artery disease (PAD) affects 8.5 million people in the United States and more than 200 million worldwide. The most significant risk factors for PAD are hyperlipidemia, hypertension, diabetes mellitus, chronic kidney disease, and smoking. Intermittent claudication (IC) is the predominant symptom of PAD, but only about 10% of patients with PAD experience IC and are associated with reduced exercise capacity. The pathophysiology of IC is characterized by different degrees of stenosis and obstruction, with a progressive reduction in distal perfusion pressure and blood flow. Supervised exercise therapy is recommended as the initial therapy for IC, but the recommendations for medical treatment of IC vary significantly. Propionyl L-carnitine is an acyl derivative of levocarnitine (L-carnitine) and is indicated for patients with the peripheral arterial occlusive disease. It corrects secondary muscle carnitine deficiency in patients with PAD, significantly improving the walking capacity; its levels increase in serum and muscle. Thus, it is suggested to enhance blood flow and oxygen supply to the muscle tissue via improved endothelial function, thereby reducing hypoxia-induced cellular and biochemical disruptions.

Highlights

BackgroundPeripheral artery disease (PAD) of the lower limbs is one manifestation of atherosclerotic vascular disease, affecting 3%-7% of the general population and 20% of individuals over 75 years [1]
L-carnitine plays an important role in transporting fatty acids across the mitochondrial membrane for oxidation and the final purpose of energy production, which happens through the carnitine shuttle
Long-chain fatty acids are converted to fatty acyl-coenzyme A (CoA) by the enzyme acyl-CoA synthase, which is subsequently converted to fatty acylcarnitine by the enzyme carnitine palmitoyltransferase I (CPT I) localized in the outer mitochondrial membrane

Summary

Introduction

BackgroundPeripheral artery disease (PAD) of the lower limbs is one manifestation of atherosclerotic vascular disease, affecting 3%-7% of the general population and 20% of individuals over 75 years [1]. PAD development is multifactorial, with a complex interplay of modifiable and non-modifiable risk factors. Cigarette smoking is one of the strongest risk factors, with over half of patients with PAD being smokers [1]. Intermittent claudication (IC) is the main symptom of PAD, defined as a very limiting cramping leg pain (in the buttock, thigh, or calf) that can markedly reduce walking speed, walking distance, and stair-climbing ability. It is associated with difficulty walking indoors and walking distance limited to typically 100-200 meters (1-2 blocks) [3]

Methods

Results

Discussion

Conclusion