1.
Lipid-lowering for peripheral arterial disease of the lower limb.
Aung, PP, Maxwell, HG, Jepson, RG, Price, JF, Leng, GC
The Cochrane database of systematic reviews. 2007;(4):CD000123
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Abstract
BACKGROUND Lipid-lowering therapy is recommended for secondary prevention in people with coronary artery disease. It may also reduce cardiovascular events and/or local disease progression in people with lower limb peripheral arterial disease (PAD). OBJECTIVES To assess the effects of lipid-lowering therapy on all-cause mortality, cardiovascular events and local disease progression in patients with PAD of the lower limb. SEARCH STRATEGY The authors searched The Cochrane Peripheral Vascular Diseases 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 peripheral arterial disease of the lower limb. SELECTION CRITERIA Randomised controlled trials of lipid-lowering therapy in patients with PAD 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 participants. 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 simvastatin in people with a blood cholesterol ≥ 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 (Weighted Mean Difference (WMD) 152 m; 95% CI 32.11 to 271.88) and pain-free walking distance (WMD 89.76 m; 95% CI 30.05 to 149.47) but no significant impact on ankle brachial index (WMD 0.04; 95% CI -0.01 to 0.09). AUTHORS' CONCLUSIONS Lipid-lowering therapy is effective in reducing cardiovascular mortality and morbidity in people with PAD. 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 people with PAD and a blood cholesterol level ≥3.5 mmol/litre is most indicated.
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[Anti-inflammatory potential of Padma 28--review of experimental data on the antiatherogenic activity and discussion of the multi-component principle].
Ueberall, F, Fuchs, D, Vennos, C
Forschende Komplementarmedizin (2006). 2006;:7-12
Abstract
BACKGROUND The Tibetan remedy Padma 28 has been used in Europe for decades and has proved to be effective in inflammatory and atherosclerotic conditions. Beyond clinical trials, a large number of in vitro and ex vivo studies report various properties and biochemical activities of this complex herbal multicompound. OBJECTIVE To give an overview of the complex efficacy profile of Padma 28, to review available data, to relate findings to the development of atherosclerosis and thus to discuss the antiatherogenic potential of Padma 28. METHODS Published non-clinical original papers on Padma 28 were collected and classified according to the studied mechanisms of action. Results were correlated to the briefly described sequences of atherogenesis and various mechanisms of action were elaborated, laying particular emphasis on more recent articles. RESULTS The complex activity profile of Padma 28 spans mainly direct and indirect anti-inflammatory proper-ties as well as further categories of biochemical actions. These can be related to the complex processes of atherogenesis. CONCLUSIONS The described mechanisms support the therapeutic field of application of Padma 28, i.e. peripheral circulatory disorders as well as chronic inflammatory disorders. Moreover, the numerous effects as well as the diversity of sites of action allow to draw first conclusions on the conceptual design of this multicomponent formula.
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Inter-relationships between arteriosclerotic risk factors: a meta-analysis.
Oh, HS, Seo, WS
Yonsei medical journal. 2000;(4):450-8
Abstract
This study was performed to clarify the overall inter-relationships between the arteriosclerotic risk factors, including smoking, alcoholic consumption, obesity, serum cholesterol and triglyceride levels, high density lipoprotein, and systolic and diastolic blood pressure using a meta analysis method. The subjects of this study were included in 24 primary studies reported in Korea since 1980, which concerned arteriosclerotic risk factors. The results show that smoking is significantly associated with total cholesterol (R = .04), triglyceride (R = .10) and HDL-cholesterol (R = -.06). Alcohol consumption is also significantly and positively associated with all three serum lipid parameters: cholesterol (R = .04), triglyceride (R = .08) and HDL-cholesterol (R = .10). The effect of smoking and alcohol consumption on cholesterol levels were found to be almost equal. However, smoking has a predominant effect on triglyceride, whereas, alcohol consumption exerts an influence primarily on the HDL-cholesterol level. Obesity was positively correlated with cholesterol (R = .25) and triglyceride (R = .21), however, it was negatively correlated with HDL-cholesterol (R = -.14). It appears that the serum lipid parameter, which shows strongest correlation with obesity, is the total cholesterol level. Obesity also showed a significant correlation with systolic (R = .19) and diastolic blood pressure (R = .13). Blood pressure was also positively correlated with cholesterol (R = .18) and triglyceride (R = .26), however, it correlated negatively with HDL-cholesterol (R = -.23). In conclusion, the overall inter-relationships between the arteriosclerotic risk factors; smoking, alcohol consumption, obesity, serum lipid level and blood pressure were all found to be significant.