title: Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis.
abstract: 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 0.38-1.01), 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.
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK. Electronic address: antoniou.ga@hotmail.com.
authors.forename: George A
authors.initials: GA
authors.lastname: Antoniou
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Fisher
authors.affiliation: Department of Vascular and Endovascular Surgery, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: George S
authors.initials: GS
authors.lastname: Georgiadis
authors.affiliation: Department of Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
authors.forename: Stavros A
authors.initials: SA
authors.lastname: Antoniou
authors.affiliation: Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK.
authors.forename: Francesco
authors.initials: F
authors.lastname: Torella
mesh_terms: D015331:Cohort Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007866:Leg / Q000098:blood supply*; D064887:Observational Studies as Topic; D058729:Peripheral Arterial Disease / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Hydroxymethylglutaryl-CoA reductase inhibitors; Peripheral arterial disease; Statin