Role of Lipid-Lowering Therapy in Peripheral Artery Disease

Belur, Agastya D.; Shah, Aangi; Virani, Salim S.; Vorla, Mounica

doi:10.3390/jcm11164872

Cited by 15 publications

(9 citation statements)

References 82 publications

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“…Screening for SRAPs using NOGA can suggest the presence or absence of embolisms in patients with peripheral arterial disease, or CLTI. The effect of lipid-lowering therapy on the decrease in the rate of amputation is controversial [ 7 , 8 ]. If CCs exacerbate LEAD, lipid-lowering therapy and anti-inflammatory agents may be potentially effective.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol Crystal Embolization Exacerbates Critical Limb Ischemia

Komatsu,

Takewa,

Santo

et al. 2024

Cureus

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Chronic life-threatening ischemia (CLTI), characterized by chronic severe ischemic ulcers or gangrene in the legs with arterial occlusive disease, has a high rate of amputation and mortality. However, how lower extremity artery disease (LEAD) leads to CLTI is not fully understood yet. Here, we report a 79-year-old man with resting pain and gangrene in the left first and fifth toes for a year who had undergone repetitive endovascular treatment (EVT) that temporarily improved the ischemia. Non-obstructive general angioscopy (NOGA) revealed yellow and red floating emboli at the occluded left superficial femoral artery (SFA). Although a second EVT for the reoccluded SFA was successful, amputation of the left lower knee remained necessary because of osteomyelitis of the left heel. Cholesterol crystals (CCs) associated with innate inflammation were detected in spontaneously ruptured aortic plaques (SRAPs) via aortic screening using the NOGA, in occluded SFAs, and on the surface of the muscle cross-section of the amputated legs via a polarizing microscope. Histopathological analysis demonstrated CCs in small vessels in various stages of patchy necrosis and muscle regeneration. In this case, the process of CC embolization, such as the embolic source of CCs, occlusion in arteries, small arteries, and deposition in muscles, was confirmed in CLTI. CCs are the principal trigger of IL-6 production through the innate inflammatory response in spontaneously ruptured aortic plaques. Mechanical ischemia and chronic inflammation due to embolized CCs may cause chronic limb damage. In this case, the CC embolization might exacerbate CLTI.

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Section: Discussionmentioning

confidence: 99%

Cholesterol Crystal Embolization Exacerbates Critical Limb Ischemia

Komatsu,

Takewa,

Santo

et al. 2024

Cureus

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“…In addition, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are emerging as an additional lipid-lowering therapy for patients with cardiovascular disease [ 79 , 80 ]. In a sub-analysis of the FOURIER trial, of a total of 27,654 participants up to the age of 85 years, 3642 patients had symptomatic PAD.…”

Section: Pharmacotherapy In the Treatment Of Atherosclerosis And Card...mentioning

confidence: 99%

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review PART II—Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory

Piechocki,

Przewłocki,

Pieniążek

et al. 2024

JCM

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Background: Aging is a key risk factor for atherosclerosis progression that is associated with increased incidence of ischemic events in supplied organs, including stroke, coronary events, limb ischemia, or renal failure. Cardiovascular disease is the leading cause of death and major disability in adults ≥ 75 years of age. Atherosclerotic occlusive disease affects everyday activity, quality of life, and it is associated with reduced life expectancy. As most multicenter randomized trials exclude elderly and very elderly patients, particularly those with severe comorbidities, physical or cognitive dysfunctions, frailty, or residence in a nursing home, there is insufficient data on the management of older patients presenting with atherosclerotic lesions outside coronary territory. This results in serious critical gaps in knowledge and a lack of guidance on the appropriate medical treatment. In addition, due to a variety of severe comorbidities in the elderly, the average daily number of pills taken by octogenarians exceeds nine. Polypharmacy frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and non-adherence. Therefore, we have attempted to gather data on the medical treatment in patients with extra-cardiac atherosclerotic lesions indicating where there is some evidence of the management in elderly patients and where there are gaps in evidence-based medicine. Public PubMed databases were searched to review existing evidence on the effectiveness of lipid-lowering, antithrombotic, and new glucose-lowering medications in patients with extra-cardiac atherosclerotic occlusive disease.

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“…Sub-optimal medical therapy for comorbid conditions has been associated with up to 26% all-cause mortality rates within the first year of CLI diagnosis [ 4 ]. Therefore, nowadays, risk factors’ aggressive treatment is considered a cornerstone in CLTI management [ 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Section: Medical Management Improving Survival In Clti and Limb Salvagementioning

confidence: 99%

Limb Salvage and Survival in Chronic Limb-Threatening Ischemia: The Need for a Fast-Track Team-Based Approach

Ventoruzzo,

Mazzitelli,

Ruzzi

et al. 2023

JCM

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Chronic limb-threatening ischemia (CLTI) represents the end-stage form of peripheral arterial disease (PAD) and is associated with a very poor prognosis and high risk of limb loss and mortality. It can be considered very similar to a terminal cancer disease, reflecting a large impact on quality of life and healthcare costs. The aim of this study is to offer an overview of the relationship between CLTI, limb salvage, and mortality, with a focus on the need of a fast-track team-based management that is a driver to achieve better survival results. This review can be useful to improve management of this growing impact disease, and to promote the standardisation of care and communication between specialist and non-specialist healthcare professionals.

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Role of Lipid-Lowering Therapy in Peripheral Artery Disease

Cited by 15 publications

References 82 publications

Cholesterol Crystal Embolization Exacerbates Critical Limb Ischemia

Cholesterol Crystal Embolization Exacerbates Critical Limb Ischemia

A Non-Coronary, Peripheral Arterial Atherosclerotic Disease (Carotid, Renal, Lower Limb) in Elderly Patients—A Review PART II—Pharmacological Approach for Management of Elderly Patients with Peripheral Atherosclerotic Lesions outside Coronary Territory

Limb Salvage and Survival in Chronic Limb-Threatening Ischemia: The Need for a Fast-Track Team-Based Approach

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