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.
Highlights
The European Society of Cardiology uses the term peripheral arterial diseases to describe atherosclerotic involvement of all arterial territories except the aorta and coronary arteries [1]
In light of the foregoing, Peripheral arterial disease (PAD) should be considered a marker of generalized atherosclerosis and these patients should be treated as subjects with high cardiovascular risk in which strict targets should be sought for all cardiovascular risk factors, including low-density lipoprotein cholesterol (LDL-C)
PAD, peripheral arterial disease; MACE, major adverse cardiovascular event; MALE, major adverse limb event; HPSCG, Heart Protection Study Collaborative Group; RCT, randomized clinical trial; R, retrospective observational study; P, prospective observational study. *Heterogeneous definitions were used between the different studies
Summary
The European Society of Cardiology uses the term peripheral arterial diseases to describe atherosclerotic involvement of all arterial territories except the aorta and coronary arteries [1]. In a meta-analysis that included 35 articles, patients with symptomatic PAD had 5-year cumulative cardiovascular mortality that was higher than that of the reference population (13 vs 5%) In this follow-up period, 7% of asymptomatic patients went on to have intermittent claudication and 21% of patients with intermittent claudication developed CLI, with 4–27% requiring amputation [22]. The cardiovascular risk associated with PAD has traditionally been underestimated and the control of cardiovascular risk factors in these patients remains deficient compared to subjects who have had a myocardial infarction or stroke [16, 30,31,32,33,34,35,36]. In light of the foregoing, PAD should be considered a marker of generalized atherosclerosis and these patients should be treated as subjects with high cardiovascular risk in which strict targets should be sought for all cardiovascular risk factors, including LDL-C
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