Statins and peripheral arterial disease

Peripheral arterial disease (PAD) in the context of this review refers to the presence of atherosclerotic disease in the arteries of the lower limbs. PAD is the third main site of atherosclerosis, after coronary heart disease and cerebrovascular disease. Intermittent claudication (IC) is the most known clinical manifestation of PAD, although most patients with leg ischemia are either asymptomatic of have atypical leg symptoms. Different drugs have been used in the past for the treatment of IC with limited results. As hypercholesterolemia is one of the main risk factors for atherosclerosis, cholesterol reduction has been shown to be effective in reducing cardiovascular morbidity and mortality. Statins are inhibitor of HMG CoA reductase, an enzyme essential in cholesterol synthesis. They effectively reduce total cholesterol and LDL cholesterol levels and are the most efficient drugs available today in the treatment of hypercholesterolemia. Several studies have demonstrated that statin administration in patients with PAD results in a decreased progression and even regression in the growth of the atherosclerotic plaque. As patients with atherosclerosis of the lower limbs have frequently concurrent coronary or cerebrovascular disease, treatment of PAD with statins results in a simultaneous decrease in the incidence of coronary events and stroke. Statins have associated pleiotropic effects, including anti-inflammatory properties that contribute to their beneficial effects and to the reduction in cardiovascular death. In addition, several studies during the last years showed that statins improved pain-free walking distance, ankle brachial index and treadmill exercise time. As a result, current guidelines for cholesterol reduction in PAD patients adhere to the same indications as for other cardiovascular diseases and strongly recommend the administration of statins in these patients.