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 .
Niacin treatment increases plasma homocyst(e)ine levels.
BACKGROUND Studies have reported high levels of plasma homocyst(e)ine as an independent risk factor for arterial occlusive disease . The Cholesterol Lowering Atherosclerosis Study reported an increase in plasma homocyst(e)ine levels in patients receiving both colestipol and niacin  compared with placebo . Thus the objective of this study was to examine the effect of niacin treatment on plasma homocyst(e)ine levels . METHODS The Arterial Disease Multiple Intervention Trial , a multicenter r and omized , placebo-controlled trial , examined the effect of niacin compared with placebo on homocyst(e)ine in a subset of 52 participants with peripheral arterial disease . RESULTS During the screening phase , titration of niacin dose from 100 mg to 1000 mg daily result ed in a 17 % increase in mean plasma homocyst(e)ine level from 13.1 + /- 4.4 micromol/L to 15.3 + /- 5.6 micromol/L ( P < .0001 ) . At 18 weeks after r and omization , there was an absolute 55 % increase from baseline in mean plasma homocyst(e)ine levels in the niacin group and a 7 % decrease in the placebo group ( P = .0001 ) . This difference remained statistically significant at the end of follow-up at 48 weeks . CONCLUSIONS Niacin substantially increased plasma homocyst(e)ine levels , which could potentially reduce the expected benefits of niacin associated with lipoprotein modification . However , plasma homocyst(e)ine levels can be decreased by folic acid supplementation . Thus further studies are needed to determine whether B vitamin supplementation to patients undergoing long-term niacin treatment would be beneficial
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 .