Prostanoids for intermittent claudication

Reiter, Markus; Bucek, Robert A.; Stümpflen, Andreas; Minar, Erich

doi:10.1002/14651858.cd000986.pub2

Cited by 17 publications

(13 citation statements)

References 29 publications

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“…Furthermore, in another pooled analysis, patients with intermittent claudication who were randomized to receive oral prostanoids demonstrated a 30% improvement in mean maximum walking distance compared with subjects receiving the placebo (85). However, in a study by Mohler et al (86) in which 897 patients with intermittent claudication were randomized to receive beraprost or placebo in a double-blinded manner for one year, there was no significant improvement in maximum walking distance in the beraprost group compared with the placebo group.…”

mentioning

confidence: 96%

Peripheral Arterial Disease in Patients With Diabetes

Marso

Hiatt

2006

Journal of the American College of Cardiology

483

344

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Peripheral arterial disease (PAD) is a chronic, lifestyle-limiting disease and is an independent predictor of cardiovascular and cerebrovascular ischemic events. Despite the recognition that PAD is associated with a marked increase in the risk of ischemic events, this particular manifestation of systemic atherosclerosis is largely underdiagnosed and undertreated. The risk of PAD is markedly increased among individuals with diabetes, and ischemic event rates are higher in diabetic individuals with PAD than in comparable non-diabetic populations. Consequently, early diagnosis and treatment of PAD in patients with diabetes is critically important in order to reduce the risk of cardiovascular events, minimize the risk of long-term disability, and improve quality of life. A diagnosis of PAD in patients with diabetes mandates a multi-faceted treatment approach, involving aggressive risk-factor modification, antiplatelet therapy, and revascularization procedures. The American Diabetes Association recently issued a consensus statement on the epidemiology, pathophysiology, diagnosis, and management of PAD in patients with diabetes. This article will review the clinical implications of the consensus statement and highlight the treatment options available in order to help prevent future ischemic events in diabetic individuals with PAD.

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confidence: 96%

Peripheral Arterial Disease in Patients With Diabetes

Marso

Hiatt

2006

Journal of the American College of Cardiology

483

344

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“…13 For intermittent claudication, prostacyclin, PGE-1 and a PGE-1 prodrug, delivered intravenously for 4-8 weeks, have been reported to increase ACD and ICD. [14][15][16][17][18][19][20][21][22][23] Intravenous delivery of drugs, often for several hours, is neither feasible nor practical in patients with intermittent claudication, but an oral formulation of prostacyclin offers the possibility of symptomatic improvement without the inconvenience of intravenous therapy.…”

Section: Discussionmentioning

confidence: 99%

A randomized trial of iloprost in patients with intermittent claudication

2008

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Prostanoids, which promote vasodilation and reduce platelet aggregation, have been proposed as candidate therapies for intermittent claudication due to peripheral arterial disease (PAD). However, studies of these medications have yielded inconsistent results. This study tested the hypothesis that iloprost, an oral prostacyclin analogue, would improve walking distance and quality of life in patients with intermittent claudication. The study was a multi-center, randomized, double-blind, placebo-controlled trial comparing three doses of oral iloprost (50 μg, 100 μg, or 150 μg twice daily), pentoxifylline, or placebo in 430 patients with intermittent claudication. The primary outcome measure was improvement in absolute claudication distance (ACD) after 6 months. Secondary outcomes included initial claudication distance and quality of life assessment. Placebo increased ACD by 3.3%, and iloprost increased peak ACD by 7.7%, 8.8% and 11.2% at the 50 μg, 100 μg, and 150 μg twicedaily doses, respectively (all insignificant relative to placebo). Pentoxifylline increased ACD by 13.9% relative to placebo (p = 0.039). Neither iloprost nor pentoxifylline enhanced quality of life. These results indicate that oral iloprost is not effective in improving exercise performance or quality of life in patients with PAD who have intermittent claudication.

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“…The prostaglandin metabolites are named based on their structural features, and designated by a letter, including PGD, PGE, PGF, PGG, and PGH, and a subscript numeral (e.g., 1,2), indicating the number of double bonds in the compound. The first prostanoid synthesized from AA is the unstable metabolite PGG 2 by incorporation of two molecules of oxygen.…”

Section: Physiology Of Eicosanoid Production and Endothelial Dysfunctionmentioning

confidence: 99%

“…Vascular cell activation was decreased after PGE 1 infusion, and this may contribute to the observed clinical benefits for treatment of peripheral arterial occlusive disease [96]. PGI 2 , administered orally or intravenously did not improve walk-ing distances in the studies presented [2]. Blood samples before and after 7-day PGE 1 treatment were assayed for MCP-1, IL-6, high-sensitivity C-reactive protein (hs-CRP), von Willebrand factor (vWF), and endothelin-1.…”

Section: Prostanoids As Current and Future Treatment Of Vascular Diseasementioning

confidence: 99%

Recent Insights into the Role of Prostanoids in Atherosclerotic Vascular Disease

Reiss

Edelman²

2006

CVP

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Atherosclerosis is characterized by chronic inflammation and enrichment of inflammatory cells in the vessel wall. Acute inflammation can lead to damaged endothelium triggering the coagulation cascade and thrombus formation. Likewise, the clotting cascade may elicit an inflammatory response. The vascular endothelium regulates vascular tone, permeability, inflammation, thrombosis, and coagulation. Dysfunction of the vascular endothelium can promote atherosclerotic disease processes. Prostanoids (prostaglandins, thromboxane, and prostacyclin) have been established as inflammatory mediators in vascular endothelial function and there continues to be growing insights into their role in atherosclerotic disease. This review examines the role of prostanoids as paracrine inflammatory mediators of atherosclerotic vascular disease, highlighting the relevant physiology of eicosanoid production and endothelial dysfunction. We consider the role of prostanoids in systemic diseases associated with high cardiovascular morbidity and mortality, including diabetes mellitus, coronary artery disease, peripheral arterial disease, rheumatologic disorders, and dyslipidemia. We present emerging evidence that cardio-protective and lipid lowering medications, such as irbesartan and simvastatin may exert their effects via prostanoid mediated pathways. Both serum and urinary prostanoids may be utilized as diagnostic predictors of disease; for example 8-iso-PGF(2alpha) in the serum has recently been reported as an independent predictor of symptomatic peripheral arterial disease. In addition, we discuss current recommendations on established therapeutic uses of prostanoids for atherosclerotic diseases, such as the use of PGE(1) for the treatment of peripheral arterial disease. Finally, we investigate original therapeutic modalities of various prostanoids involved in the aforementioned diseases.

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Prostanoids for intermittent claudication

Cited by 17 publications

References 29 publications

Peripheral Arterial Disease in Patients With Diabetes

Peripheral Arterial Disease in Patients With Diabetes

A randomized trial of iloprost in patients with intermittent claudication

Recent Insights into the Role of Prostanoids in Atherosclerotic Vascular Disease

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