Atheroma (fatty deposits) in the walls of the arteries to the legs can lead to peripheral arterial disease with insufficient blood flow to the muscles and other tissues. People with peripheral arterial disease often do not have symptoms. The most common symptom is intermittent claudication, which is characterised by leg pain and weakness brought on by walking, with disappearance of the symptoms following a brief rest. Lipid-lowering therapies may reduce cardiovascular events and worsening of local disease for people with lower limb peripheral arterial disease. They are recommended to people with coronary artery disease, for prevention of myocardial infarction and stroke.
Eighteen randomised controlled trials were included in the review, involving a total of 10,049 participants (78% were men) from seven different countries. The trials compared lipid-lowering therapy with placebo or usual treatment for at least 90 days. They differed considerably in the inclusion criteria, outcomes measured, and type of lipid-lowering therapy used. Lipid-lowering therapies improved walking distance. The effect of lipid-lowering therapy on death from any cause in people with peripheral artery disease was inconclusive. Using drugs to lower blood lipids had a beneficial effect on the incidence of total cardiovascular events, due primarily to an overall reduction in coronary events (OR 0.8; 95% Confidence Interval 0.7 to 0.9). The only type of drug for which consistent, clear evidence of a beneficial effect on total cardiovascular events, total coronary events and stroke was available, was the statins. The greatest evidence was with simvastatin in people with a blood cholesterol level of at least 3.5 mmol/litre. The evidence on side effects was inconclusive in these trials.