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Cholesterol reduction in patients with lower limb atherosclerotic disease
Jean Bismuth1, Steen Christian Kofoed, Henrik H Sillesen
1Department of Vascular Surgery, County Hospital, Gentofte.
Insights
Peripheral arterial disease (PAD) patients face high mortality due to atherosclerosis. Treating dyslipidaemia, a key risk factor, may improve survival in these individuals.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Atherosclerosis Research
Background:
- Peripheral arterial disease (PAD) is associated with a 2-3 fold increased mortality risk.
- Critical limb ischemia, the most severe PAD stage, carries a 50% mortality rate within 4-5 years.
- High mortality in PAD patients stems from concurrent coronary and cerebrovascular atherosclerotic disease.
Purpose of the Study:
- To review current evidence on the benefits of treating dyslipidaemia in patients with peripheral arterial disease.
- To assess the applicability of findings from coronary artery disease trials to PAD patients.
- To highlight the potential of lipid modification therapies in improving PAD outcomes.
Main Methods:
- Systematic review of existing randomized trials and epidemiological data.
- Analysis of studies focusing on cardiovascular risk factors, particularly dyslipidaemia.
- Extrapolation of evidence from coronary artery disease populations to peripheral arterial disease patients.
Main Results:
- Dyslipidaemia is a major modifiable risk factor for atherosclerosis.
- Lipid-lowering therapies significantly reduce cardiovascular morbidity and mortality in patients with and without coronary artery disease.
- Evidence suggests these benefits are transferable to patients with PAD.
Conclusions:
- Active treatment of dyslipidaemia is warranted in patients with peripheral arterial disease.
- Managing lipid profiles can potentially improve survival rates in PAD.
- Further research directly investigating lipid modification in PAD is supported by existing evidence.
Abstract:
Patients with peripheral arterial disease (PAD) have a 2-3 times increased risk of death and in the most severe stage, critical peripheral ischaemia, the mortality rate is around 50% within 4-5. This poor survival rate is due to concomitant coronary and cerebrovascular atherosclerotic disease. Among the major risk factors for atherosclerosis are dyslipidaemia, smoking, hypertension and diabetes. Large randomised trials have shown that dyslipidaemia is easily modifiable in both patients with and without established coronary artery disease, with significant reductions in cardiovascular morbidity and mortality. Although none of these trials directly measured peripheral vascular status, there is every indication that conclusions submitted for patients with ischaemic heart disease can be translated to patients with peripheral vascular disease. The object of this review was therefore to divulge current evidence available supporting active treatment of dyslipidaemia in patients with peripheral vascular disease.