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Meta-Analysis
. 2007 Oct 17;2007(4):CD000123.
doi: 10.1002/14651858.CD000123.pub2.

Lipid-lowering for peripheral arterial disease of the lower limb

P P Aung  1 , H G Maxwell, R G Jepson, J F Price, G C Leng
Affiliations
Meta-Analysis

Lipid-lowering for peripheral arterial disease of the lower limb

P P Aung et al. Cochrane Database Syst Rev. .

Abstract

Background: Lipid-lowering therapy is recommended for secondary prevention in people with coronary artery disease. It may also reduce cardiovascular events and/or local disease progression in people with lower limb peripheral arterial disease (PAD).

Objectives: To assess the effects of lipid-lowering therapy on all-cause mortality, cardiovascular events and local disease progression in patients with PAD of the lower limb.

Search strategy: The authors searched The Cochrane Peripheral Vascular Diseases Group's Specialised Register (last searched February 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2007) for publications describing randomised controlled trials of lipid-lowering therapy in peripheral arterial disease of the lower limb.

Selection criteria: Randomised controlled trials of lipid-lowering therapy in patients with PAD of the lower limb.

Data collection and analysis: Three authors independently assessed trial quality and extracted data.

Main results: Eighteen trials were included, involving a total of 10,049 participants. Trials differed considerably in their inclusion criteria, outcomes measured, and type of lipid-lowering therapy used. Only one trial (PQRST) reported a detrimental effect of active treatment on blood lipid/lipoprotein levels. The pooled results from all eligible trials indicated that lipid-lowering therapy had no statistically significant effect on overall mortality (Odds Ratio (OR) 0.86; 95% Confidence Interval (CI) 0.49 to 1.50) or on total cardiovascular events (OR 0.8; 95% CI 0.59 to 1.09). However, subgroup analysis which excluded PQRST showed that lipid-lowering therapy significantly reduced the risk of total cardiovascular events (OR 0.74; CI 0.55 to 0.98). This was primarily due to a positive effect on total coronary events (OR 0.76; 95% CI 0.67 to 0.87). Greatest evidence of effectiveness came from the use of simvastatin in people with a blood cholesterol >/= 3.5 mmol/litre (HPS). Pooling of the results from several small trials on a range of different lipid-lowering agents indicated an improvement in total walking distance (Weighted Mean Difference (WMD) 152 m; 95% CI 32.11 to 271.88) and pain-free walking distance (WMD 89.76 m; 95% CI 30.05 to 149.47) but no significant impact on ankle brachial index (WMD 0.04; 95% CI -0.01 to 0.09).

Authors' conclusions: Lipid-lowering therapy is effective in reducing cardiovascular mortality and morbidity in people with PAD. It may also improve local symptoms. Until further evidence on the relative effectiveness of different lipid-lowering agents is available, use of a statin in people with PAD and a blood cholesterol level >/=3.5 mmol/litre is most indicated.

PubMed Disclaimer

Conflict of interest statement

JP has received research funding from Pfizer plc and Bayer plc.

Figures

1.1
1.1. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 1 All‐cause mortality.
1.2
1.2. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 2 Total cardiovascular events.
1.3
1.3. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 3 Fatal cardiovascular.
1.4
1.4. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 4 Non‐fatal cardiovascular events.
1.5
1.5. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 5 Total coronary.
1.6
1.6. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 6 Fatal coronary event.
1.7
1.7. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 7 Non‐fatal coronary event.
1.8
1.8. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 8 Total stroke.
1.9
1.9. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 9 Fatal stroke.
1.10
1.10. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 10 Non‐fatal stroke.
1.11
1.11. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 11 Revascularization (HMG Co A Group / Statins).
1.12
1.12. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 12 Pain‐free walking distance (PFWD).
1.13
1.13. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 13 Total walking distance (TWD).
1.14
1.14. Analysis
Comparison 1 Any lipid‐lowering regimen vs control: all trials, Outcome 14 Ankle brachial index (ABI).
See this image and copyright information in PMC

Update of

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Saunders 2000 {published data only}
    1. Saunders E, Ferdinand K, Yellen LG, Tonkon MJ, Krug‐Gourley S, Poland, M. Efficacy and safety of cerivastatin and pravastatin in the treatment of primary hypercholesterolemia. Journal of the National Medical Association 2000;92(7):319‐326. [MEDLINE: ] - PMC - PubMed
Schumer 1963 {published data only}
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Smith 1981 {published data only}
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Tyson 1979 {published data only}
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References to studies awaiting assessment

Borreani 1993 {published data only}
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Degni 1973 {published data only}
    1. Degni M, Cilurzo O. Treatment of obstructive atherosclerosis of the lower extremities with the ER‐113V. Revista Brasileira Cardiovascular 1973;9(2):83‐98.
Di Stefano 1984 {published data only}
    1. Stefano F, Patane S, Vinci M. Medical treatment of atherosclerosis: Controlled clinical trial with new glycosaminoglycan: Sulodexide. European Review for Medical & Pharmacological Sciences 1984;6(3):525‐532.
Mayer 2001 {published data only}
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Additional references

BNF
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References to other published versions of this review

Leng 1996
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