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
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 .
Randomized placebo-controlled study of the effects of simvastatin on haemostatic variables, lipoproteins and free fatty acids. The Oxford Cholesterol Study Group.
The Oxford Cholesterol Study is a r and omized placebo-controlled trial design ed primarily to assess the effects of simvastatin on blood cholesterol levels and side-effects in preparation for a large , long-term trial of the effects of cholesterol-lowering drug therapy on mortality . At present there is only limited evidence from r and omized comparisons of the effects of HMG-CoA reductase inhibitors , such as simvastatin , on thrombogenic , as distinct from atherogenic , pathways in coronary heart disease . The present sub- study was carried out to assess the effects of simvastatin on a range of haemostatic variables , as well as on free fatty acids and on lipoprotein fractions not studied in detail previously . At an average of about 2 years after starting study treatment , non-fasting blood sample s were obtained from a sequential sample of 162 participants who had been r and omly allocated to receive 40 mg ( 54 patients ) or 20 mg ( 57 patients ) daily simvastatin or matching placebo treatment ( 51 patients ) . Only patients who reported taking their study treatment and who were not known to be diabetic or to be taking some other lipid lowering treatment were to be included . The principal comparisons were to be of those allocated simvastatin ( i.e. 20 and 40 mg doses combined ) vs those allocated placebo . Among patients allocated simvastatin , marginally significant lower factor VII antigen levels ( 12.10 % + /- 6.08 of st and ard ; 2P < 0.05 ) and non-significantly lower factor VII coagulant activity ( 8.24 % + /- 4.99 of st and ard ) and fibrinogen concentrations ( 0.10 + /- 0.08 g. l-1 ) were observed . In contrast , plasminogen activator inhibitor activity was significantly higher ( 2.62 + /- 1.03 IU ; 2P < 0.01 ) among patients allocated simvastatin . No significant differences were seen in the other haemostatic factors studied ( e.g. prothrombin fragment 1.2 , factor XII and C1 inhibitor ) . Total free fatty acid concentration was marginally significantly reduced ( 2P = 0.02 ) with simvastatin , but none of the reductions in individual free fatty acids was significant . Lipoprotein fractions were only measured among patients allocated 40 mg daily simvastatin or placebo . Compared with placebo , simvastatin produced significant decreases not only in LDL cholesterol ( 1.74 + /- 0.15 mmol.1(-1 ) : 2P < 0.0001 ) but also in VLDL cholesterol ( 0.28 + /- 0.08 mmol.1(-1 ) ; 2P < 0.001 ) and IDL cholesterol ( 0.17 + /- 0.03 mmol.1(-1 ) ; 2P < 0.0001 ) . There were also lower triglyceride levels associated with LDL ( 0.07 + /- 0.01 mmol.1(-1 ) ; 2P < 0.0001 ) , IDL ( 0.03 + /- 0.01 mmol.1(-1 ) ; 2P < 0.01 ) and VLDL ( 0.27 + /- 0.14 ; 2P = 0.05 ) . The effects of simvastatin on haemostatic variables appear to be far less marked than its lipid effects . Given the associations of haemostatic factors with coronary heart disease incidence , larger r and omized comparisons of the HMG-CoA reductase inhibitors ( and of the newer fibrates which may produce greater effects ) are needed to provide more reliable estimates of the extent to which they influence these variables
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
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 .