Beyond Cholesterol Reduction: Statin Pleiotropy and Peripheral Arterial Disease

Abstract

Lower extremity peripheral arterial disease (PAD) is the atherosclerotic obstruction of the lower extremity arteries that can lead to walking impairment, non-healing open wounds, gangrene or limb loss. It is estimated that PAD affects greater than 200 million people worldwide and is associated with advanced age, tobacco use, diabetes, hypertension, and hypercholesterolemia. Initial management of PAD involves risk factor modification and pharmacologic strategies, including the implementation of statin therapy. Statins, the most commonly used cholesterol lowering medications, also have beneficial pleiotropic (cholesterol independent) effects including improved patency rates from vascular reconstruction, decreased risk of stroke, myocardial infarction and improved survival. In this chapter, we will discuss the relevant clinical trials, prospective observation and retrospective studies that exemplify the effect of statins on PAD. We will then focus on statin’s cellular effects on endothelial and vascular smooth muscle cell function by examining effects on plaque progression, intimal hyperplasia, re-endothelialization, and angiogenesis/arteriogenesis.