Coppola Giuseppe, Novo Salvatore
Department of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, University of Palermo, Chair of Cardiovascular Disease, Palermo, Italy.
Arch Med Res. 2007 Jul;38(5):479-88. doi: 10.1016/j.arcmed.2006.12.012.
Peripheral arterial disease (PAD) of the lower limbs is the third most important site of atherosclerotic disease alongside coronary heart disease (CHD) and cerebrovascular disease (CVD). Best medical treatment is beneficial even in patients who eventually need invasive treatment, as the safety, immediate success, and durability of intervention is greatly improved in patients who adhere to best medical treatment. In recent years, a number of studies have suggested that the ACE-inhibitor ramipril and different statins, together with antiplatelet drugs, reduce cardiovascular morbidity and mortality in PAD. Patients with PAD are really a category of patients with a very high cardiovascular risk burden for fatal and nonfatal cerebrovascular and cardiovascular events; therefore, they need to be treated not only for local problems deriving from arteriopathy (intermittent claudication, rest pain and/or ulcers) but, above all, for preventing vascular events. Statins not only lower the risk of vascular events, but they also improve the symptoms associated with PAD. Statins exert beneficial pleiotropic effects on hemostasis, vasculature and inflammatory markers; there is also evidence that statins improve renal function considering that the plasma creatinine level is considered as an emerging vascular risk factor.
下肢外周动脉疾病（PAD）是除冠心病（CHD）和脑血管疾病（CVD）之外的第三大重要动脉粥样硬化疾病部位。即使对于最终需要进行侵入性治疗的患者，最佳药物治疗也是有益的，因为坚持最佳药物治疗的患者进行干预的安全性、即刻成功率和耐久性会大大提高。近年来，多项研究表明，血管紧张素转换酶抑制剂雷米普利和不同的他汀类药物，与抗血小板药物一起，可降低PAD患者的心血管发病率和死亡率。PAD患者确实是一类心血管风险负担极高的患者，易发生致命和非致命的脑血管及心血管事件；因此，他们不仅需要治疗因动脉病变引起的局部问题（间歇性跛行、静息痛和/或溃疡），更重要的是，要预防血管事件。他汀类药物不仅能降低血管事件风险，还能改善与PAD相关的症状。他汀类药物对止血、血管系统和炎症标志物具有有益的多效性作用；也有证据表明，鉴于血浆肌酐水平被视为一种新出现的血管危险因素，他汀类药物可改善肾功能。
