What is the role of lipid-lowering therapy in patients with PAD?
Reducing cholesterol with a statin has been shown to reduce the risk of cardiovascular events in patients with PAD. Therefore, due to their high risk of MI and stroke, all PAD patients who have high serum cholesterol should be treated. SIGN recommends this to be all patients with a cholesterol level greater than 3.5mmol/l. The lipid profile should be measured before and after starting treatment, to ensure that a 25% reduction in cholesterol is being achieved. Direct evidence supporting the use of statins to lower LDL cholesterol levels in PAD comes from the Heart Protection Study. In this study 20,536 high-risk individuals with a total cholesterol level of at least 3.5mmol/l were randomised to receive either simvastatin 40mg daily or placebo. A lowering of cholesterol by 25% with the statin reduced cardiovascular mortality and morbidity in patients with PAD but no prior coronary disease, producing a highly significant reduction of 22% in the first occurrence of a major vascular event.7
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