Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis

Objective: To investigate and analyse the existing evidence supporting statin therapy in patients with lower limb atherosclerotic arterial disease. Methods: A systematic search of electronic information sources was undertaken to identify studies comparing cardiovascular outcomes in patients with lower limb peripheral arterial disease treated with a statin and those not receiving a statin. Estimates were combined applying fixed- or random-effects models. Results: Twelve observational cohort studies and two randomised trials reporting 19,368 patients were selected. Statin therapy was associated with reduced all-cause mortality (odds ratio 0.60, 95% confidence interval 0.46-0.78) and incidence of stroke (odds ratio 0.77,95% confidence interval 0.67-0.89). A trend towards improved cardiovascular mortality (odds ratio 0.62,95% confidence interval 0.35-1.11), myocardial infarction (odds ratio 0.62,95% confidence interval 038-1.01), and the composite of death/myocardial infarction/stroke (odds ratio 0.91, 95% confidence interval 0.81-1.03), was identified. Meta-analyses of studies performing adjustments showed decreased all-cause mortality in statin users (hazard ratio 0.77, 95% confidence interval 0.68-0.86). Conclusions: Evidence supporting statins' protective role in patients with lower limb peripheral arterial disease is insufficient. Statin therapy seems to be effective in reducing all-cause mortality and the incidence cerebrovascular events in patients diagnosed with peripheral arterial disease. (C) 2014 Elsevier Inc. All rights reserved.