Lipid-lowering for XXXX of the lower limb.

@entity1 @entity1095 @entity66 @entity3657 @entity3413 @entity353 @entity158 @entity453 @entity165
BACKGROUND: Lipid-lowering therapy is recommended for secondary prevention in @entity1 with @entity453 . It may also reduce cardiovascular events and/or @entity66 progression in @entity1 with @entity3657 ( @entity3657 ). OBJECTIVES: To assess the effects of lipid-lowering therapy on all-cause mortality, cardiovascular events and @entity66 progression in @entity1 with @entity3657 of the lower limb. SEARCH STRATEGY: The authors searched The Cochrane @entity1095 Group's Specialised Register (last searched February 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 2, 2007) for publications describing randomised controlled trials of lipid-lowering therapy in @entity3657 of the lower limb. SELECTION CRITERIA: Randomised controlled trials of lipid-lowering therapy in @entity1 with @entity3657 of the lower limb. DATA COLLECTION AND ANALYSIS: Three authors independently assessed trial quality and extracted data. MAIN RESULTS: Eighteen trials were included, involving a total of 10,049 @entity1 . Trials differed considerably in their inclusion criteria, outcomes measured, and type of lipid-lowering therapy used. Only one trial (PQRST) reported a detrimental effect of active treatment on blood lipid/lipoprotein levels. The pooled results from all eligible trials indicated that lipid-lowering therapy had no statistically significant effect on overall mortality (Odds Ratio (OR) 0.86; 95% Confidence Interval (CI) 0.49 to 1.50) or on total cardiovascular events (OR 0.8; 95% CI 0.59 to 1.09). However, subgroup analysis which excluded PQRST showed that lipid-lowering therapy significantly reduced the risk of total cardiovascular events (OR 0.74; CI 0.55 to 0.98). This was primarily due to a positive effect on total coronary events (OR 0.76; 95% CI 0.67 to 0.87). Greatest evidence of effectiveness came from the use of @entity3413 in @entity1 with a blood @entity165 >/= 3.5 mmol/litre (HPS). Pooling of the results from several small trials on a range of different lipid-lowering agents indicated an improvement in total walking distance ( @entity353 ( @entity353 ) 152 m; 95% CI 32.11 to 271.88) and @entity158 -free walking distance ( @entity353 89.76 m; 95% CI 30.05 to 149.47) but no significant impact on ankle brachial index ( @entity353 0.04; 95% CI -0.01 to 0.09). AUTHORS' CONCLUSIONS: Lipid-lowering therapy is effective in reducing cardiovascular mortality and morbidity in @entity1 with @entity3657 . It may also improve local symptoms. Until further evidence on the relative effectiveness of different lipid-lowering agents is available, use of a statin in @entity1 with @entity3657 and a blood @entity165 level >/=3.5 mmol/litre is most indicated.
