Statins in Peripheral Artery Disease

Article, see p 1435 Atherosclerotic peripheral artery disease (PAD) is a growing, yet underappreciated global health issue.1 PAD affects >200 million individuals worldwide,2 and atherosclerotic disease of the lower extremities confers a high risk of cardiovascular events and death.3 Patients with PAD have a 2.5-fold increased risk of myocardial infarction and a 3.1-fold increased risk of stroke in comparison with healthy individuals.3 In addition, individuals with PAD are at heightened risk for lower extremity ulceration, acute limb ischemia, surgical and percutaneous revascularization, and amputation. Given the prevalence and morbidity of PAD, there is a clear need for therapies that improve PAD-specific outcomes, such as amputation, and reduce the risk of other major cardiovascular events that are common among patients with atherosclerosis, as well. Current professional society guidelines recommend statin therapy for all individuals with PAD.4,5 Unfortunately, much of the data regarding lipid-lowering therapy for PAD have been extrapolated from studies of coronary artery disease, and few studies have specifically examined limb outcomes. The Heart Protection Study randomly assigned 20 536 subjects, 6748 of whom carried a diagnosis of PAD, to either simvastatin 40 mg daily or placebo with a mean follow-up of 5 years.6 In the overall study population, simvastatin was associated with a 16% relative risk reduction in peripheral vascular events, which was driven primarily by a 20% reduction in noncoronary revascularization. It is noteworthy that this end point included not only lower extremity arterial procedures, but …