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 .
Three-year follow-up of the Oxford Cholesterol Study: assessment of the efficacy and safety of simvastatin in preparation for a large mortality study.
We report the results of a r and omized single-centre study design ed to assess the effects of simvastatin on blood lipids , blood biochemistry , haematology and other measures of safety and tolerability in preparation for a large-scale multicentre mortality study . Six hundred and twenty-one individuals considered to be at increased risk of coronary heart disease were r and omized , following a 2-month placebo ' run-in ' period , to receive 40 mg daily simvastatin , 20 mg daily simvastatin or matching placebo .  Their mean age was 63 years , 85 % were male , 62 % had a history of prior myocardial infa rct ion ( MI ) , and the mean baseline total cholesterol was 7.0 mmol.l-1 . Median follow-up in the present report is 3.4 years . Eight weeks after r and omization , 40 mg daily simvastatin had reduced non-fasting total cholesterol by 29.2 % + /- 1.1 ( 2.03 + /- 0.08 mmol.l-1 ) and 20 mg daily simvastatin had reduced it by 26.8 % + /- 1.0 ( 1.87 + /- 0.07 mmol.l-1 ) . Almost all of the difference in total cholesterol at 8 weeks was due to the reduction in LDL cholesterol ( 40.8 % + /- 1.6 and 38.2 % + /- 1.4 among patients allocated 40 mg and 20 mg of simvastatin daily respectively ) , but simvastatin also reduced triglycerides substantially ( 19.0 % and 17.3 % ) and produced a small increase in HDL cholesterol ( 6.4 % and 4.8 % ) . These effects were largely sustained over the next 3 years , with 40 mg daily simvastatin producing a slightly greater reduction in total cholesterol at 3 years ( 25.7 % + /- 1.9 reduction ) than did 20 mg daily simvastatin ( 22.2 % + /- 1.8 ) . There were no differences between the treatment groups in the numbers of reports of ' possible adverse effects ' of treatment or of a range of different symptoms or conditions ( including those related to sleep or mood ) recorded at regular clinic follow-up . Mean levels of alanine aminotransferase , aspartate aminotransferase and creatine kinase were slightly increased by treatment , but there were no significant differences between the treatment groups in the numbers of patients with significantly elevated levels . A slightly lower platelet count in the simvastatin group was the only haematological difference from placebo , with no difference in the numbers of patients with low platelet counts . In summary , the simvastatin regimens studied produced large sustained reductions in total cholesterol , LDL cholesterol and triglyceride and small increases in HDL cholesterol . They were well tolerated , with no evidence of serious side-effects during the first 3 years of this study . ( ABSTRACT TRUNCATED AT 400 WORDS
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 .