Related Experiment Video
Updated: Jul 5, 2025
Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
Published on: October 12, 2017
Dyslipidemia and peripheral arterial disease
Ajay Yadav1, Vivek Sawant1, Varinder Singh Bedi1
1Institutions: Sir Ganga Ram Hospital, India.
Insights
Peripheral arterial disease (PAD) affects 12% of adults and increases cardiovascular death risk. Lipid-lowering therapies show promise, but research is needed on their impact on limb salvage in PAD patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Peripheral arterial disease (PAD) affects 12% of the global adult population, with increasing prevalence.
- Polyvascular disease, involving PAD with atherosclerosis in multiple arterial beds (CAD, mesenteric/renal, CVD), is common, affecting 1 in 6 patients per the REACH registry.
- Progression to critical limb ischaemia (CLI) in PAD patients carries a 10-15 fold increased risk of cardiovascular death.
Purpose of the Study:
- To review current management strategies for dyslipidaemia in very high-risk patients, including those with PAD.
- To highlight the efficacy of lipid-lowering agents like statins, ezetimibe, and PCSK9 inhibitors in reducing cardiovascular events.
- To emphasize the need for an Indian multi-disciplinary task force to investigate the impact of lipid-lowering agents on limb salvage and major limb events in PAD.
Main Methods:
- Review of existing literature and clinical trial data on PAD, polyvascular disease, and lipid-lowering therapies.
- Analysis of guideline recommendations for dyslipidaemia management in high-risk populations.
- Examination of data from registries like REACH and trials such as IMPROVE-IT and FOURIER.
Main Results:
- High-intensity statin therapy significantly reduces all-cause mortality, CV death, CV outcomes, stroke, acute limb ischaemia, and amputations in PAD patients.
- Combination therapy with ezetimibe and statins (IMPROVE-IT) further reduces major adverse cardiovascular events (MACE).
- PCSK9 inhibitors demonstrate a reduction in primary endpoints, with a notable benefit in PAD patients compared to non-PAD patients (3.5% vs 1.6% in FOURIER trial).
Conclusions:
- Optimal management of dyslipidaemia in PAD patients remains a challenge, despite proven benefits of lipid-lowering agents.
- There is a critical need for focused research in India to understand the direct impact of lipid-lowering therapies on limb salvage and limb-related events in PAD.
- Establishing an Indian multi-disciplinary task force is essential for advancing research and improving outcomes for PAD patients.
Abstract:
Peripheral arterial disease (PAD) affects 12 % of adult population and is increasing globally and in India. Peripheral arterial disease when associated with atherosclerosis in two or more other arterial beds such as coronary artery disease (CAD), mesenteric/renal artery and cerebrovascular disease (CVD), is known as polyvascular disease. The Reduction of Atherothrombosis for Continued Health (REACH) registry reported that 1 out of 6 patients had multi-vascular bed involvement. Progression of PAD to critical limb ischaemia (CLI) is seen in 1 % of affected patients per year, but patients who progress to CLI may have a 10- to 15-fold increased risk of cardiovascular death. The 2019 ECS/EAS guidelines for the management of dyslipidaemias have suggested that for primary or secondary prevention in very high risk, patients should follow a therapeutic regimen that achieves >50 % LDL-C reduction from baseline and an LDL-C goal of <55 mg/dl. High Intensity Statin is mainstay of treatment but optimal management is inadequate. Statin treatment reduces all-cause mortality by 39 %, CV death by 41 %, CV outcomes by 34 %, ischaemic stroke by 28 %, acute limb ischaemia by 30 % and amputations by 35 %. Ezetimibe when added to statins in IMPROVE-IT trial, showed significant reduction of MACE. PCSK9 inhibitor (FOURIER TRIAL) showed reduction in primary end point in PAD vs Non PAD patients (3.5 % vs 1.6 %). There is a critical need for an Indian multi-disciplinary task force for research on the direct impact of lipid-lowering agents on limb salvage rates and major limb-related events in PAD patients.
Related Concept Videos
01:29Cholesterol: Significance and Regulation
Considering cholesterol and...
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:24Overview of Lipid Metabolism
Lipolysis: The Breakdown of Lipids:
Lipolysis is the process of breaking down lipids, particularly triglycerides, into glycerol and fatty acids. This process typically occurs in the adipose tissue and is triggered by various hormones, including glucagon and...
01:38Inflammation
01:18Lipids: Dietary Sources and Requirements