In a large randomized trial, simvastatin significantly reduced the incidence of major vascular events among patients with PAD.
Although statins are commonly prescribed for
patients with peripheral arterial disease (PAD), large cholesterol-lowering
trials have not been conducted specifically in this patient population. To fill
this gap, U.K. researchers took advantage of the randomized Heart Protection
Study, in which 20,536 patients — all of whom had total cholesterol 
135 mg/dL and coronary disease, other
occlusive arterial disease, diabetes, or hypertension — received 40 mg of
simvastatin or placebo daily. Previously published results from this study
focused on coronary and stroke outcomes (Journal
Watch Jul 30 2002); now, the researchers focus on PAD.
Nearly 7000 patients had PAD (i.e., claudication or previous peripheral revascularization) at baseline. During 5 years of treatment, simvastatin significantly reduced the incidence of major vascular events (coronary events, stroke, or any revascularization) as follows:
-- 26.4% versus 32.7% (simvastatin vs. placebo) among the 6748 patients with PAD
-- 24.7% versus 30.5% among 2701 patients with PAD but no history of coronary disease
-- 25.4% versus 31.1% among 2034 patients with PAD and LDL cholesterol <116 mg/dL
In addition, among patients with baseline PAD, the incidence of subsequent peripheral vascular events (revascularization, aneurysm repair, amputation, or PAD death) was lower with simvastatin than with placebo (10.1% vs. 12.0%).
Comment: In this study, simvastatin reduced the incidence of major vascular events by about 6 percentage points in peripheral arterial disease patients generally, and in PAD patients with no history of coronary disease or with relatively low cholesterol levels. Moreover, a small but significant reduction in peripheral vascular procedures was noted. These results suggest that statins should be prescribed routinely for patients with PAD.
— Allan S. Brett, MD
Published in Journal Watch General Medicine April 24, 2007