Effectiveness of Propionyl-L-Carnitine Supplementation on Exercise Performance in Intermittent Claudication: A Systematic Review

Abstract

Lower extremity peripheral artery disease (PAD) affects 8.5 million people in the United States and more than 200 million worldwide. The most significant risk factors for PAD are hyperlipidemia, hypertension, diabetes mellitus, chronic kidney disease, and smoking. Intermittent claudication (IC) is the predominant symptom of PAD, but only about 10% of patients with PAD experience IC and are associated with reduced exercise capacity. The pathophysiology of IC is characterized by different degrees of stenosis and obstruction, with a progressive reduction in distal perfusion pressure and blood flow. Supervised exercise therapy is recommended as the initial therapy for IC, but the recommendations for medical treatment of IC vary significantly. Propionyl L-carnitine is an acyl derivative of levocarnitine (L-carnitine) and is indicated for patients with the peripheral arterial occlusive disease. It corrects secondary muscle carnitine deficiency in patients with PAD, significantly improving the walking capacity; its levels increase in serum and muscle. Thus, it is suggested to enhance blood flow and oxygen supply to the muscle tissue via improved endothelial function, thereby reducing hypoxia-induced cellular and biochemical disruptions.

The Role of Physiotherapy in Peripheral Artery Disease in Patients With Diabetes Mellitus: A Narrative Review

“…These programs should be individualized. Starting as little as 10 minutes for walking per session and increasing walking per session by 5 minutes per week until patients are walking for exercise 45 to 50 minutes per session to progressively increase walking resistance before the onset of intermittent claudication or pain [86][87][88]. The degree of benefit of supervised and home-based exercise programs has not yet been demonstrated [89,90].…”

“…However, not all patients with PAD can perform them; for example, those who present intermittent claudication because they report pain [39,96]. The patients are recommended to follow the same criteria as home-based exercise, starting as little as 10 minutes for walking per session and increasing walking per session by 5 minutes per week until patients are walking for exercise 45 to 50 minutes per session [88,97,98].…”

Selected Plant-Derived Polyphenols as Potential Therapeutic Agents for Peripheral Artery Disease: Molecular Mechanisms, Efficacy and Safety

“…Additionally, various vasoactive drugs could be used to treat symptoms, such as improving walking distances [ 2 ]. Furthermore, propionyl-L-carnitine has been suggested to alleviate PAD symptoms through a metabolic pathway, thus improving exercise performance [ 9 , 10 , 11 ]. In addition, gene therapy using encoding genes of various types of growth factors is at the beginning stage [ 12 ].…”

“…Unfortunately, its diagnosis is often made too late and occurs when symptoms are marked, delaying a preventive treatment [ 15 ]. Insulin resistance, commonly manifested in type 2 diabetes mellitus (T2DM), is a consequence of several risk factors represented by obesity, sedentary behavior and aging; therefore, hyperglycemia, diabetes, hypertension and dyslipidemia are concomitant diseases often observed in patients affected by PAD [ 10 ]. In patients with DM, the diagnosis of symptomatic PAD is approximately twice as high as in patients not affected by diabetes [ 16 ].…”